Evaluation of hospital wide utilization of the heparin dosing protocol for deep vein thrombosis (dvt) and pulmonary embolism (pe) in the obese population
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"Baseline demographics and indications for the heparin drip were similar between the two groups. The obese population had higher rates of supra-therapeutic anti-factor Xa levels, however did not lead to a shorter time to achieving either a therapeutic or a supra-therapeutic heparin level. Sub-group analysis revealed that approximately 30.1 percent of the obese were not dosed per protocol. The most common way prescribers breached protocol was with-holding the bolus dose. The first and third quartile of the initial anti-factor Xa level was unacceptably high in the obese patients dosed per protocol (0.6 units/ml-1.39 units/ml). There was almost a doubling of in hospital mortality in the obese population (13 percent versus 7 percent). Our study was not adequately powered to catch statistical difference in safety outcomes, however there seems to be an increased trend in mortality in obese patients dosed on our heparin protocol. Recommend capping the initial bolus regimen in obese patients. Recommend an initial infusion rate of 16 units/kg/hour in obese patients <130kg, and recommend an initial infusion rate of 12 units/kg/hour in obese patients >130 kg."--Conclusions.
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