Overview

Safety and Efficacy of Lean Body Weight-based IV Heparin Dosing in Obese/Morbidly Obese Patients

Status:
Unknown status
Trial end date:
2014-12-01
Target enrollment:
0
Participant gender:
All
Summary
Standard weight-based IV heparin for normal weight patients is based on actual body weight (ABW). However, no well-defined guidelines have been established for patients considered to be obese or morbidly obese. In current practice, the calculated ABW based heparin initial bolus dose and infusion rates are quite high, and therefore often not used for obese/morbidly obese patients for fear of bleeding. Heparin is distributed in the body approximately the same as blood and does not get distributed to adipose tissue. There are some studies suggesting that lean body weight (LBW) might be a better basis for dosing heparin. LBW is a calculated weight that excludes the weight of fat. The investigators hypothesize that intravenous heparin dosing based on the Lean body weight of obese/morbidly obese patients would be safe and effective in achieving a therapeutic level of heparin in 24 hours compared to the usual practice in this patient population.
Phase:
N/A
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Nazareth Hospital
Treatments:
Calcium heparin
Heparin
Criteria
Inclusion Criteria:

- Patients with body mass index greater than or equal to 30

- Patients admitted to Nazareth Hospital inpatient units

- Weight-based intravenous heparin, with a diagnosis of atrial fibrillation, suspected
or confirmed deep vein thrombosis or pulmonary embolism, unstable angina or Non ST
elevation myocardial infarction with hemodynamic stability, or peripheral vascular
disease, ordered at the time of admission/transfer or during the patient stay in the
Intensive Care unit or Progressive Care unit.

- Prior permission from the patient's attending physician

- Permission from the physician who ordered the intravenous weight-based heparin (if
different from the attending)

- Signed consent form by the patient.

Exclusion Criteria:

- Patients with stroke, TIA, or ST elevation myocardial infarction

- Patients who have hemodynamic or cardiopulmonary instability at the time of
intravenous heparin order

- Patients with thrombophilia

- Patients who are pregnant or may be pregnant

- Those patients who have been on any oral anticoagulants (Warfarin, rivaroxaban,
dabigatran or apixaban), treatment dose of other anticoagulants or intravenous
thrombolytics in previous 7 days.

- Patients who have a PTT greater than 37 seconds.

- History of heparin-induced thrombocytopenia or known allergy to heparin

- Deviation from the Weight-based heparin protocol ordered by a physician at the time
intravenous heparin was written (i.e. no bolus dose ordered, different target
therapeutic aPTT range, different bolus dose per kg, etc.)

- Informed consent either refused or not obtained

- Objection from a physician caring for the patient