Treatment of Pulmonary Embolism in an Extremely Obese Patient

Authors: Diepstraten, Jeroen¹; Kralingen, Simone²; Snijder, Repke³; Hackeng, Christian⁴; Ramshorst, Bert⁵; Knibbe, Catherijne⁶

Source: Obesity Surgery, Volume 19, Number 8, August 2009 , pp. 1186-1189(4)

Publisher: Springer

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By this author: Diepstraten, Jeroen ; Kralingen, Simone ; Snijder, Repke ; Hackeng, Christian ; Ramshorst, Bert ; Knibbe, Catherijne

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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.

Keywords: Anti-Xa activity; Low-molecular-weight heparin; Morbid obesity; Pulmonary embolism; Tinzaparin

Document Type: Research article

DOI: 10.1007/s11695-009-9886-7

Affiliations: 1: Department of Clinical Pharmacy, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands 2: Department of Anaesthesiology, St. Antonius Hospital, Nieuwegein, The Netherlands 3: Department of Pulmonary Diseases, St. Antonius Hospital, Nieuwegein, The Netherlands 4: Department of Clinical Chemistry, St. Antonius Hospital, Nieuwegein, The Netherlands 5: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands 6: Department of Clinical Pharmacy, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands, Email: c.knibbe@antoniusziekenhuis.nl