体重指数对基于体重的未分级肝素剂量调整中出血频率和活化部分凝血活酶时间的影响：一项回顾性队列研究。
Effect of body mass index on bleeding frequency and activated partial thromboplastin time in weight-based dosing of unfractionated heparin: a retrospective cohort study.
机构信息
Department of Pharmacy/JJN1-02, Cleveland Clinic, Cleveland, OH 44195, USA.
出版信息
Mayo Clin Proc. 2009 Dec;84(12):1073-8. doi: 10.4065/mcp.2009.0220.
OBJECTIVE
To assess bleeding and activated partial thromboplastin time (APTT) in relation to body mass index (BMI) in patients prescribed weight-based dosing of intravenous unfractionated heparin (UFH) for cardiac indications without a maximum (dose-capped) initial bolus or capped initial infusion rate.
PATIENTS AND METHODS
Consecutive patients admitted to an academic medical center from February 1, 2002, through November 31, 2003, who were treated with a UFH nomogram consisting of a 60-U/kg intravenous bolus plus an initial continuous intravenous infusion of 12 U/kg hourly and titrated to a goal APTT range corresponding to thromboplastin-adjusted target heparin levels of 0.3 to 0.7 U/mL by anti-Xa assay were evaluated for this retrospective cohort study. Patients were excluded if they concomitantly received a fibrinolytic, glycoprotein IIb/IIIa inhibitor, or any other antithrombotic agent (except warfarin). Study patients were divided into quartiles by BMI.
RESULTS
Of the 1054 patients included in the study, 807 (76.6%) had an initial bolus dose higher than 4000 U, and 477 (45.3%) had an initial infusion rate higher than 1000 U/h. Despite a significant difference among BMI quartiles in proportion of supratherapeutic first APTT values (P<.001), no statistically significant difference was found in bleeding frequency (P=.26) or frequency of first APTT within the goal range (P=.27). Logistic regression analyses revealed that BMI was not a significant predictor of bleeding or first APTT within the goal range.
CONCLUSION
We did not find any difference in the proportion of first APTT values in the goal range or an increased risk of bleeding in obese patients treated with UFH without a capped initial dose. Our data demonstrate the safe use of weight-based UFH without a capped initial bolus dose or capped initial infusion rate in patients with medical cardiac conditions.
目的
评估体重指数（BMI）与接受静脉普通肝素（UFH）体重剂量治疗的心脏疾病患者的出血和激活部分凝血活酶时间（APTT）之间的关系，这些患者没有最大（剂量封顶）初始推注或初始输注率封顶。
方法
对 2002 年 2 月 1 日至 2003 年 11 月 31 日期间连续入住学术医疗中心的患者进行回顾性队列研究，这些患者使用 UFH 列线图治疗，包括 60-U/kg 静脉推注，初始持续静脉输注 12 U/kg/小时，并滴定至与抗 Xa 测定相对应的目标 APTT 范围，以达到调整组织因子的肝素靶目标水平 0.3 至 0.7 U/mL。如果患者同时接受纤维蛋白溶解剂、糖蛋白 IIb/IIIa 抑制剂或任何其他抗血栓药物（除华法林外），则将其排除在研究之外。根据 BMI 将研究患者分为四分位数。
结果
在纳入研究的 1054 例患者中，807 例（76.6%）初始推注剂量高于 4000 U，477 例（45.3%）初始输注率高于 1000 U/h。尽管在 BMI 四分位数之间，首次 APTT 值高于治疗范围的比例存在显著差异（P<.001），但出血频率（P=.26）或首次 APTT 值在目标范围内的频率（P=.27）无统计学差异。逻辑回归分析显示，BMI 不是出血或首次 APTT 值在目标范围内的显著预测因素。
结论
我们发现，在未接受初始剂量封顶的肥胖患者中，UFH 治疗时首次 APTT 值在目标范围内的比例或出血风险没有差异。我们的数据表明，在患有心脏疾病的患者中，使用基于体重的 UFH 且不进行初始剂量封顶或初始输注率封顶是安全的。
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