title: Evaluation of weight-based dosing of unfractionated heparin in obese children.
abstract: OBJECTIVE
  To determine whether pediatric patients with obesity receiving weight-based dosages of unfractionated heparin (UFH) exhibit an enhanced response when dosed by actual body weight compared with nonobese patients as assessed primarily by the frequency of supratherapeutic anticoagulation. Secondary measures included UFH doses associated with therapeutic anticoagulation.
  
  
  METHODS
  This single-institution retrospective case-matched study included children with and without obesity, matched on a 1:1 basis, who received a weight-based continuous infusion of UFH. Therapeutic monitoring values were defined for activated partial thromboplastin time (aPTT) level (70-101 seconds) and anti-activated factor X (Xa) level (0.35-0.7 U/mL).
  
  
  RESULTS
  The study included 50 children. The percentage of patients with supratherapeutic anticoagulation at any point in the study, as measured by either aPTT or anti-Xa level, was similar in the obese and nonobese groups (76% vs 72%; P = 1.0). However, compared with patients without obesity, those with obesity received a lower mean starting dose (17.4 vs 20.2 U/kg/hour; P = .013) and a lower mean maintenance dose (19.1 vs 24.3 U/kg/hour; P = .033) to achieve stable therapeutic monitoring test values. There was no difference in mean initial post-UFH aPTT between the 2 groups, but the mean initial anti-Xa level was higher in the obese group (0.45 vs 0.29 U/mL; P = .045).
  
  
  CONCLUSIONS
  Compared with children without obesity, those with obesity who received actual body weight-based continuous UFH infusions did not exhibit a higher frequency of supratherapeutic anticoagulation, but did require lower dosages to achieve comparable anticoagulation. Our results highlight recognized discrepancies between aPTT and anti-Xa monitoring assays.
authors: Department of Pharmacy, Texas Children's Hospital, Houston, TX, USA. breann.taylor@cchmc.org
authors: Breann N
authors: BN
authors: Taylor
authors: Sara J D
authors: SJ
authors: Bork
authors: Shelly
authors: S
authors: Kim
authors: Brady S
authors: BS
authors: Moffett
authors: Donald L
authors: DL
authors: Yee
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage*; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D054796:Drug Dosage Calculations; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D009765:Obesity / Q000097:blood; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D006493:Heparin