Unfractionated heparin dosing for therapeutic anticoagulation in critically ill obese adults

E. M. Hohner, R. M. Kruer, V. T. Gilmore, M. Streiff, H. Gibbs

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Research evaluating unfractionated heparin (UFH) dosing in obese critically ill populations is limited. This study aimed to determine optimal weight-based and total therapeutic infusion rates of UFH in this population. Methods: This retrospective cohort study compared adults on UFH infusions in intensive care units from May 2011 through October 2013 across 3 weight strata: 95 to 104 kg (control), 105 to 129 kg (high weight), and greater than or equal to 130 kg (higher weight). Primary outcomes included total and weight-based infusion rates for therapeutic anticoagulation. Results: To achieve therapeutic activated partial thromboplastin times, higher weight patients had higher mean infusion rates compared with control (2017 vs 1582 U/h; P = .002). Mean weight-based therapeutic infusion rate was lower in the higher weight group compared with control (13.1 vs 15.8 U kg-1 h-1; P = .008). Post hoc analyses indicated mean weight-based infusion rate to achieve therapeutic anticoagulation was 15 U kg-1 h-1 in patients less than 165 kg and 13 U kg-1 h-1 in patients greater than 165 kg. Conclusions: Patients greater than or equal to 130 kg have lower weight-based heparin requirements compared with patients 95 to 104 kg. This difference appears to be driven by patients greater than 165 kg. Patients greater than 165 kg have lower weight-based heparin requirements, whereas patients from 105 to 164 kg have weight-based requirements similar to a normal-weight patient population. Initiating heparin at appropriate weight-based doses for obese patients may optimize anticoagulation.

Original languageEnglish (US)
Pages (from-to)395-399
Number of pages5
JournalJournal of Critical Care
Volume30
Issue number2
DOIs
StatePublished - Apr 1 2015

Keywords

  • Anticoagulation
  • Critically ill
  • Heparin
  • Obesity

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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