title: Use of a modified dosing weight for heparin therapy in a morbidly obese patient.
abstract: OBJECTIVE
  To report a case of successful anticoagulation using a modified dosing weight (DW) for unfractionated heparin (UFH) therapy in a morbidly obese female.
  
  
  METHODS
  A 54-year-old morbidly obese (182.4 kg, 155 cm) white female presented to the emergency department with tachycardia, shortness of breath, and chest pain, and was diagnosed with a pulmonary embolism. Anticoagulation with UFH was initiated. A modified DW of 120 kg was obtained from the average of the actual body weight (ABW) and ideal body weight ( approximately 50 kg). We selected this modified DW to account for heparin's altered volume of distribution in an obese patient and avoid potentially supratherapeutic activated partial thromboplastin times (aPTTs) using ABW and subtherapeutic aPTTs using DW. Therapy was initiated with a bolus dose of 9600 units (80 units/kg x 120 kg) and continuous infusion rate of 2160 units/h (18 units/kg/h x 120 kg). This infusion rate was maintained throughout the course of heparin therapy and was successful in maintaining therapeutic aPTTs.
  
  
  CONCLUSIONS
  Proper diagnosis and rapid initiation of therapy prevent mortality in patients with PE. Although weight-based heparin nomograms provide standardization through initial bolus and continuous infusion recommendations, many do not address dosing in morbidly obese patients. Several retrospective studies have evaluated actual, dosing, and ideal body weights for heparin therapy in obese patients; however, none has evaluated modified DW. In our patient, successful anticoagulation was objectively confirmed.
  
  
  CONCLUSIONS
  Further investigation is necessary to determine the optimal DW for UFH in morbidly obese patients presenting with acute thrombosis.
authors.affiliation: Kaiser Permanente, Englewood, CO 80110-1526, USA. sarah.j.schwiesow@kp.org
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Schwiesow
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Wessell
authors.forename: Terrence E
authors.initials: TE
authors.lastname: Steyer
mesh_terms: D001835:Body Weight / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood*; D011655:Pulmonary Embolism / Q000097:blood / Q000188:drug therapy
chemical_list: D006493:Heparin