用于危重症肥胖成人治疗性抗凝的普通肝素剂量
Unfractionated heparin dosing for therapeutic anticoagulation in critically ill obese adults.
作者信息
Hohner E M, Kruer R M, Gilmore V T, Streiff M, Gibbs H
机构信息
Department of Pharmacy, The Johns Hopkins Hospital, 600 N Wolfe St, Carnegie 180, Baltimore, MD 21287, USA.
Department of Pharmacy, The Johns Hopkins Hospital, 600 N Wolfe St, Carnegie 180, Baltimore, MD 21287, USA.
出版信息
J Crit Care. 2015 Apr;30(2):395-9. doi: 10.1016/j.jcrc.2014.11.020. Epub 2014 Dec 3.
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.
目的
评估普通肝素（UFH）在肥胖重症患者中的给药剂量的研究有限。本研究旨在确定该人群中基于体重的最佳和总治疗输注速率。
方法
这项回顾性队列研究比较了2011年5月至2013年10月在重症监护病房接受UFH输注的成年人，分为3个体重层：95至104千克（对照组）、105至129千克（高体重组）和大于或等于130千克（更高体重组）。主要结局包括治疗性抗凝的总输注速率和基于体重的输注速率。
结果
为达到治疗性活化部分凝血活酶时间，更高体重组患者的平均输注速率高于对照组（2017对1582 U/小时；P = 0.002）。更高体重组基于体重的平均治疗输注速率低于对照组（13.1对15.8 U·kg⁻¹·h⁻¹；P = 0.008）。事后分析表明，体重小于165千克的患者达到治疗性抗凝的基于体重的平均输注速率为15 U·kg⁻¹·h⁻¹，体重大于165千克的患者为13 U·kg⁻¹·h⁻¹。
结论
与95至104千克的患者相比，体重≥130千克的患者基于体重的肝素需求量更低。这种差异似乎是由体重超过165千克的患者导致的。体重超过165千克的患者基于体重的肝素需求量更低，而体重在105至164千克之间的患者基于体重的需求量与正常体重患者群体相似。以适当的基于体重的剂量为肥胖患者起始使用肝素可能会优化抗凝效果。
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