Skip to main content
SpringerLink
Log in

Treatment of Pulmonary Embolism in an Extremely Obese Patient

  • Case Report
  • Published:
Obesity Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Eikelboom JW, Karthikeyan G, Fagel N, et al. American Association of Orthopedic Surgeons and American College Of Chest Physicians guidelines for venous thromboembolism prevention in hip and knee arthroplasty differ: what are the implications for clinicians and patients? Chest. 2009;135(2):513–20.

    Article  Google Scholar 

  2. Hainer JW, Barrett JS, Assaid CA, et al. Dosing in heavy-weight/obese patients with the LMWH, tinzaparin: a pharmacodynamic study. Thromb Haemost. 2002;87(5):817–23.

    Article  CAS  Google Scholar 

  3. Barrett JS, Gibiansky E, Hull RD, et al. Population pharmacodynamics in patients receiving tinzaparin for the prevention and treatment of deep vein thrombosis. Int J Clin Pharmacol Ther. 2001;39(10):431–46.

    CAS  PubMed  Google Scholar 

  4. Hull RD, Raskob GE, Pineo GF, et al. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis. N Engl J Med. 1992;326(15):975–82.

    Article  CAS  Google Scholar 

  5. Montalescot G, Collet JP, Tanguy ML, et al. Anti-Xa activity relates to survival and efficacy in unselected acute coronary syndrome patients treated with enoxaparin. Circulation. 2004;110(4):392–8.

    Article  CAS  Google Scholar 

  6. Hirsh J, Raschke R. Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):188S–203S.

    Article  CAS  Google Scholar 

  7. Kopelman PG. Obesity as a medical problem. Nature. 2000;404(6778):635–43.

    Article  CAS  Google Scholar 

  8. World Health Organisation. Obesity: preventing and managing the global epidemic. Geneva: World Health Organisation; 1997.

    Google Scholar 

  9. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295(13):1549–55.

    Article  CAS  Google Scholar 

  10. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163(14):1711–7.

    Article  Google Scholar 

  11. Goldhaber SZ, Grodstein F, Stampfer MJ, et al. A prospective study of risk factors for pulmonary embolism in women. JAMA. 1997;277(8):642–5.

    Article  CAS  Google Scholar 

  12. Wells PS, Anderson DR, Rodger MA, et al. A randomized trial comparing 2 low-molecular-weight heparins for the outpatient treatment of deep vein thrombosis and pulmonary embolism. Arch Intern Med. 2005;165(7):733–8.

    Article  CAS  Google Scholar 

  13. Hull RD. Treatment of pulmonary embolism: the use of low-molecular-weight heparin in the inpatient and outpatient settings. Thromb Haemost. 2008;99(3):502–10.

    Article  CAS  Google Scholar 

  14. Neely JL, Carlson SS, Lenhart SE. Tinzaparin sodium: a low-molecular-weight heparin. Am J Health Syst Pharm. 2002;59(15):1426–36.

    CAS  PubMed  Google Scholar 

  15. Wilson SJ, Wilbur K, Burton E, et al. Effect of patient weight on the anticoagulant response to adjusted therapeutic dosage of low-molecular-weight heparin for the treatment of venous thromboembolism. Haemostasis. 2001;31(1):42–8.

    CAS  PubMed  Google Scholar 

  16. Davidson BL, Buller HR, Decousus H, et al. Effect of obesity on outcomes after fondaparinux, enoxaparin, or heparin treatment for acute venous thromboembolism in the Matisse trials. J Thromb Haemost. 2007;5(6):1191–4.

    Article  CAS  Google Scholar 

  17. Heizmann M, Baerlocher GM, Steinmann F, et al. Anti-Xa activity in obese patients after double standard dose of nadroparin for prophylaxis. Thromb Res. 2002;106(4–5):179–81.

    Article  CAS  Google Scholar 

  18. Borkgren-Okonek MJ, Hartm DR, Pantanom DJ, et al. Enoxaparin thromboprophylaxis in gastric bypass patients: extended duration, dose stratification, and antifactor Xa activity. Surg Obes Relat Dis. 2008;4(5):625–31.

    Article  Google Scholar 

  19. Green B, Duffull SB. What is the best size descriptor to use for pharmacokinetic studies in the obese? Br J Clin Pharmacol. 2004;58(2):119–33.

    Article  Google Scholar 

  20. Barras MA, Duffull SB, Atherton JJ, et al. Individualized compared with conventional dosing of enoxaparin. Clin Pharmacol Ther. 2008;83(6):882–8.

    Article  CAS  Google Scholar 

  21. Paige JT, Gouda BP, Gaitor-Stampley V, et al. No correlation between anti-factor Xa levels, low-molecular-weight heparin, and bleeding after gastric bypass. Surg Obes Relat Dis. 2007;3(4):469–75.

    Article  Google Scholar 

  22. Buller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):401S–428S.

    Article  CAS  Google Scholar 

  23. Pedersen PC, Ostergaard PB, Hedner U, et al. Pharmacokinetics of a low molecular weight heparin, logiparin, after intravenous and subcutaneous administration to healthy volunteers. Thromb Res. 1991;61(5–6):477–87.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Pharmacy, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands

    Jeroen Diepstraten & Catherijne A. J. Knibbe

  2. Department of Anaesthesiology, St. Antonius Hospital, Nieuwegein, The Netherlands

    Simone van Kralingen

  3. Department of Pulmonary Diseases, St. Antonius Hospital, Nieuwegein, The Netherlands

    Repke J. Snijder

  4. Department of Clinical Chemistry, St. Antonius Hospital, Nieuwegein, The Netherlands

    Christian M. Hackeng

  5. Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands

    Bert van Ramshorst

Authors
  1. Jeroen Diepstraten
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simone van Kralingen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Repke J. Snijder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian M. Hackeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bert van Ramshorst
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Catherijne A. J. Knibbe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherijne A. J. Knibbe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Diepstraten, J., van Kralingen, S., Snijder, R.J. et al. Treatment of Pulmonary Embolism in an Extremely Obese Patient. OBES SURG 19, 1186–1189 (2009). https://doi.org/10.1007/s11695-009-9886-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-009-9886-7

Keywords

Search

Navigation