What is the best anticoagulant for obese patients?
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In patients with a BMI of 40-50 kg/m2, warfarin should be used, but apixaban or edoxaban can be considered. In obese patients with a BMI > 50 kg/m2, warfarin should be used.
What weight do you use for heparin dosing?
It is reasonable to consider one of the following formulas: dosing weight = ideal body weight (IBW) + 0.3(actual body weight [ABW] – IBW), or dosing weight = IBW + 0.4(ABW – IBW). Key Words: heparin dosing, obesity, venous thromboembolism, VTE, pulmonary embolism, PE.
How is weight based enoxaparin dosed in an obese patient?
Use standard treatment dosing (ie, 1 mg/kg every 12 hours based on TBW). Once-daily dosing regimens of enoxaparin are not recommended. BMI 30 to 39 kg/m2: Use standard prophylaxis dosing (ie, 30 mg every 12 hours or 40 mg once daily).
Is heparin dosed by adjusted body weight?
The dosing of heparin based on actual body weight (units/kg/h) and time to first therapeutic aPTT was similar between groups, but dose was statistically higher at steady state in the non-obese (16.3 ± 5.3 non-obese, 11.6 ± 5.5 obese and 11.1 ± 1.2 obese, P = 0.01) with similar times to steady state.
How do obese patients treat VTE?
In our experience, treatment of acute VTE in patients who are morbidly obese is most safely achieved by using intravenous unfractionated heparin and concomitant warfarin.
Is IV heparin weight-based?
Standard weight-based IV heparin for normal weight patients is based on actual body weight (ABW). However, no well-defined guidelines have been established for patients considered to be obese or morbidly obese.
How is heparin calculated?
- Heparin Infusion Rate: 25,000 units = 1500 units/hour.
- 500ml.
- X (ml/hour)
- 25,000 units (X ml/hr) = 750,000.
- X ml/hr = 750,000.
- 25,000.
- X = 30 ml/hour.
How is Lovenox dosed?
Usual dose is a single intravenous bolus of 30 mg plus a 1 mg/kg subcutaneous dose followed by 1 mg/kg subcutaneously every 12 hours (max 100 mg for the first two doses), with aspirin. The usual duration of Lovenox treatment duration therapy is 8 days or until hospital discharge.
What weight should I use for enoxaparin?
Once-daily dosing regimens of enoxaparin are not recommended. BMI 30 to 39 kg/m2: Use standard prophylaxis dosing (ie, 30 mg every 12 hours or 40 mg once daily). Some experts use weight-based dosing (ie, 0.5 mg/kg based on TBW once or twice daily, depending upon level of VTE risk).
Can you use DOAC in obese patients?
Obesity is a known risk factor for VTE, AF, and cardiovascular diseases. The use of DOACs should be avoided in patients after bariatric surgery, pending further clinical trials. Standard VTE prevention doses of DOACs can be used in patients who are morbidly obese and require thromboprophylaxis after surgery.