title: Treatment of pulmonary embolism in an extremely obese patient.
abstract: Low-molecular-weight heparins are effective as initial therapy for pulmonary embolism (PE) in a weight-based dosing regimen up to known body weights of 160 kg. The present case reports an extremely obese man of 252 kg (body mass index (BMI) 74 kg/m2) with PE who was treated with tinzaparin, dosed on a body weight of 160 kg. Morbid obesity defined as a BMI higher than 40 kg/m2 is becoming more common in general practice, but there are no evidence-based drug dosing strategies for these patients. This case demonstrates the successful use of a maximum dose of 28,000 anti-Xa international units of tinzaparin for an extremely obese patient with proven PE, instead of the accepted doses of 175 IU/kg, as bridge therapy to a coumarin.
authors.affiliation: Department of Clinical Pharmacy, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Diepstraten
authors.forename: Simone
authors.initials: S
authors.lastname: van Kralingen
authors.forename: Repke J
authors.initials: RJ
authors.lastname: Snijder
authors.forename: Christian M
authors.initials: CM
authors.lastname: Hackeng
authors.forename: Bert
authors.initials: B
authors.lastname: van Ramshorst
authors.forename: Catherijne A J
authors.initials: CA
authors.lastname: Knibbe
mesh_terms: D000074:Acenocoumarol / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D054796:Drug Dosage Calculations; D016903:Drug Monitoring; D015951:Factor Xa / Q000187:drug effects; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D011517:Prothrombin Time; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D000078222:Tinzaparin
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D000078222:Tinzaparin; D015951:Factor Xa; D000074:Acenocoumarol