957: EVALUATION OF WEIGHT-BASED DOSING OF UNFRACTIONATED HEPARIN IN CRITICALLY ILL OBESE PATIENTS

Background: Delays in time to therapeutic activated partial thromboplastin time (aPTT) have been associated with poor outcomes in patients with acute pulmonary embolism (PE). Objective: To investigate the relationship between time to therapeutic anticoagulation and in-hospital mortality in critically ill, obese patients with acute PE. Methods: This study examined 204 critically ill patients with a body mass index (BMI) ≥30 kg/m2 receiving unfractionated heparin (UFH) for PE treatment. Patients achieving therapeutic anticoagulation within 24 hours of UFH initiation (early) were compared to those in >24 hours (delayed). Additional end points included 30-day mortality, median time to therapeutic aPTT, proportion of therapeutic and supratherapeutic aPTT values, hemodynamic deterioration, thrombolytic therapy after UFH initiation, length of stay, and bleeding. Results: No difference in in-hospital or 30-day all-cause mortality was seen (odds ratio [OR]: 1.33, confidence interval [CI]: 0.647-2.72; OR: 1.003, CI: 0.514-1.96). Patients in the early group had a greater proportion of therapeutic aPTT values (66.7% vs 50%, P < .001) and higher percentage of supratherapeutic aPTT values (20.9% vs 11.3%, P < .001); however, no increase in clinically significant bleeding was evident (15.2% vs 10.9%, P = .366). Conclusion: In this population, a shorter time to therapeutic aPTT was not associated with improved survival.

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Severity of Illness Scores May Misclassify Critically Ill Obese Patients*

Critical Care Medicine ◽

10.1097/ccm.0000000000002868 ◽

2018 ◽

Vol 46 (3) ◽

pp. 394-400 ◽

Cited By ~ 10

Author(s):

Rodrigo Octávio Deliberato ◽

Stephanie Ko ◽

Matthieu Komorowski ◽

M. A. Armengol de La Hoz ◽

Maria P. Frushicheva ◽

...

Keyword(s):

Critically Ill ◽

Severity Of Illness ◽

Obese Patients

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Agreement between activated partial thromboplastin time and anti-Xa activity in critically ill patients receiving therapeutic unfractionated heparin

Thrombosis Research ◽

10.1016/j.thromres.2019.01.002 ◽

2019 ◽

Vol 175 ◽

pp. 53-58 ◽

Cited By ~ 2

Author(s):

Damian Ratano ◽

Lorenzo Alberio ◽

Frederik Delodder ◽

Mohamed Faouzi ◽

Mette M. Berger

Keyword(s):

Unfractionated Heparin ◽

Critically Ill ◽

Critically Ill Patients ◽

Partial Thromboplastin Time ◽

Activated Partial Thromboplastin Time

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Population Pharmacokinetics of Piperacillin in Nonobese, Obese, and Morbidly Obese Critically Ill Patients

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01276-16 ◽

2017 ◽

Vol 61 (3) ◽

Cited By ~ 21

Author(s):

Abdulaziz S. Alobaid ◽

Steven C. Wallis ◽

Paul Jarrett ◽

Therese Starr ◽

Janine Stuart ◽

...

Keyword(s):

Critical Illness ◽

Population Pharmacokinetics ◽

Critically Ill ◽

Critically Ill Patients ◽

Central Compartment ◽

Pharmacokinetic Analysis ◽

Peripheral Compartment ◽

Morbidly Obese ◽

Obese Patients ◽

Intercompartmental Clearance

ABSTRACT The treatment of infections in critically ill obese and morbidly obese patients is challenging because of the combined physiological changes that result from obesity and critical illness. The aim of this study was to describe the population pharmacokinetics of piperacillin in a cohort of critically ill patients, including obese and morbidly obese patients. Critically ill patients who received piperacillin-tazobactam were classified according to their body mass index (BMI) as nonobese, obese, and morbidly obese. Plasma samples were collected, and piperacillin concentrations were determined by a validated chromatographic method. Population pharmacokinetic analysis and Monte Carlo dosing simulations were performed using Pmetrics software. Thirty-seven critically ill patients (including 12 obese patients and 12 morbidly obese patients) were enrolled. The patients' mean ± standard deviation age, weight, and BMI were 50 ± 15 years, 104 ± 35 kg, and 38.0 ± 15.0 kg/m2, respectively. The concentration-time data were best described by a two-compartment linear model. The mean ± SD parameter estimates for the final covariate model were a clearance of 14.0 ± 7.1 liters/h, a volume of distribution of the central compartment of 49.0 ± 19.0 liters, an intercompartmental clearance from the central compartment to the peripheral compartment of 0.9 ± 0.6 liters · h−1, and an intercompartmental clearance from the peripheral compartment to the central compartment of 2.3 ± 2.8 liters · h−1. A higher measured creatinine clearance and shorter-duration infusions were associated with a lower likelihood of achieving therapeutic piperacillin exposures in patients in all BMI categories. Piperacillin pharmacokinetics are altered in the presence of obesity and critical illness. As with nonobese patients, prolonged infusions increase the likelihood of achieving therapeutic concentrations.

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