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Eptifibatide dosing in obesity in the united:

The primary endpoint for this study was steady-state plasma eptifibatide concentrations 12—18 hours after the eptifibatide infusion had begun.

Ethan Walker
Saturday, May 12, 2018
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  • No excess included doses within or below the recommended range.

  • Gretler DD .

  • Factors associated with excess dosing included older age, as well as female sex, renal insufficiency, low body weight, diabetes mellitus, and congestive heart failure. Effect of weight, sex, age, clinical diagnosis, and thromboplastin reagent on steady-state intravenous heparin requirements.

  • A scatterplot of concentration by weight with the 3 regression lines for each dosing regimen based on the ANCOVA model is presented Figure 1.

  • Prediction of creatinine clearance from serum creatinine.

Publication types

Choose either the "Merged" or "Side-by-Side" comparison format to specify how the two study versions are to be displayed. Race was collected as reported in the medical record white, black, Asian, Pacific Islander, American Indian, or other. Chen, MS ; Matthew T. Rent this article from DeepDyve.

Outcome Measures Primary Outcome Measures: 1. Table 2. Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account. February 6, Recommended antithrombotic dose was defined eptifibatide dosing in obesity in the united accordance with package inserts, guidelines, and clinical trial publications Table 1. The purpose this study is to assess whether a tirofiban regimen of a high-dose bolus plus a shortened infusion duration compared to label-dosing eptifibatide in patients undergoing percutaneous coronary intervention PCI is associated with a non-inferior composite rate of death, PCI-related myocardial infarction, urgent target vessel revascularization or in-hospital major bleeding within 48 hours following PCI or hospital discharge, whichever comes first. Original Contribution.

September 24, Bridgewater, NJ: Aventis Pharmaceuticals; February 6, Study Population. These factors, if anything, would lead to an underestimation of dosing errors as well as their association with adverse clinical outcomes. Am J Health Syst Pharm. Create a free personal account to make a comment, download free article PDFs, sign up for alerts and more.

ABW Eptifibatide bolus, mg Much of the published clinical eptifibatide dosing in obesity in the united PK evidence to date eptifiibatide of small patient populations and are retrospective with, not infrequently, heterogeneous results that in some cases are contradictory. Further study is warranted to define the optimal dosing of eptifibatide and other antithrombotic therapies in obese patients. Pre- and post-eptifibatide platelet aggregation units in for each patient in the standard dosing group aABW dosing group band IBW dosing group c. Conclusion 9. Recent history Saved searches.

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Table 1. FDA-regulated Drug:. Am J Cardiol. Relationship of incorrect dosing of fibrinolytic therapy and clinical outcomes.

Studies evaluating eptifibatide had uniited upper weight pressure N mm Hg or diastolic blood pressure N mm limit above which patients received the same fixed Hgserum creatinine N2. The proportion of patients istration in all groups. Enter the email address you signed up with and we'll email you a reset link. All rights reserved.

Hobbach HPSchuster P. ABW eptifibatide dosing leads to higher plasma concentrations and greater platelet inhibition than standard or IBW dosing in obese patients undergoing PCI. American Heart Journal Vavalle et al December Although patients were randomized in this study, a baseline imbalance of relevant factors cannot be excluded. Values presented as median 25th, 75th.

In the ABW group, platelet aggregation fell to 2 0, 8 from, and in the Dosinf group it decreased to 14 8, 20 from In the standard dosing group, post-drug platelet aggregation fell to a median of 7 0, 21 frommeasured before drug administration. The study was not powered to assess the effect of different dosing regimens on clinical outcomes. Rapid platelet-function bolus administration during percutaneous coronary revascularization assay: an automated and quantitative cartridge-based method. Cohen MG .

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Copyright notice. This website requires cookies, and the limited processing of your personal data in order to function. Conclusion 9. The Kinetics of Integrilin Limited by Obesity: A multicenter randomized pharmacokinetic and pharmacodynamic clinical trial American Heart Journal, J Am Coll Cardiol ;

Further study is jn to define the optimal dosing of eptifibatide and other antithrombotic therapies in obese patients. Please send your change of address notification at least 6 weeks before your move to ensure continued service. It is possible that the use of another assay 6. Despite the evidence from Schering Plough Pharmaceuticals, now Merck- that current dosing recommendations for medications Schering Plough.

Additionally, dosing guides on standard order forms, clinical pharmacists on rounds, and multidisciplinary teams can double-check dosing accuracy. Further study is warranted to define the optimal dosing of eptifibatide and other medications in obese patients. Renal insufficiency was determined by a serum creatinine level of more than 2. Original Contribution. February 27,

Publications

Effects of computerized physician order entry on prescribing practices. Enoxaparin [package insert]. Of those patients administered excess UFH, Similarly, completeness and accuracy of the CRUSADE database was high in an audited sample, but events are not adjudicated and underreporting is possible. One each from columns A and B.

Eptifibatide dosing is weight adjusted for patients up to kg. J Invasive Cardiol. External link. Figure 2. By Marco Valgimigli.

  • UFH was administered in excess to Of those patients administered excess UFH,

  • Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults.

  • The relative increase in bleeding with excess dosing rate of bleeding in patients receiving excess dose minus rate of bleeding in those not dosed excessively was applied to the total number of patients receiving excess doses of each agent to arrive at the incremental dose-associated bleeding. Purchase access Subscribe to the journal.

N Engl J Med. Affiliations 1 author 1. Publisher's Disclaimer: This is a PDF file of eptifubatide unedited manuscript that has been accepted for publication. Pharmacodynamics and pharmacokinetics of higher-dose, double-bolus eptifibatide in percutaneous coronary intervention. Information on platelet count, receptor blockade with high-dose integrilin in coronary intervention: either before or after eptifibatide administration, was not results of the PRIDE study abstract. American Heart Journal Vavalle et al December PAU, Platelet aggregation unit.

Integrilin Eptifibatide eptifibatide dosing in obesity in the united insert]. Conditions Conditions:. Race was collected as reported in the medical record white, black, Asian, Pacific Islander, American Indian, or other. We describe the initial bolus and infusion rates of antithrombotic therapies administered during the first 24 hours to patients with NSTE ACS. Importantly, we demonstrated that after adjusting for patient factors, dosing errors remain associated with increased bleeding, particularly when multiple agents are administered in excess. Hover over the " Recruitment Status " to see how the study's recruitment status changed.

Samples were collected from a peripheral vein into pre-chilled 10 mL EDTA tubes 12—18 hours after the start of infusion and while the infusion was still running. Novel dosing regimen of eptifibatide in planned coronary stent implantation ESPRIT : a randomised, placebo-controlled trial. ABW eptifibatide dosing leads to higher plasma concentrations and greater platelet inhibition than standard or IBW dosing in obese patients undergoing PCI.

Ideal body weight was similar among all 3 dosing strategies Table II. Lancet ; Despite higher standard dosing group. PCI, patients unitdd randomized by sealed envelope in a Alternatively, because eptifibatide has a limited volume fashion to 1 of 3 open-label eptifibatide-dosing regimens: 1 of distribution and does not distribute well into adipose standard dosing with two Aguirre, MD, g Daniel D. N Engl J Med ; A meta-analysis of N10, patients from 22 studies Steven R.

Committee on Quality of Health Care in America. The interesting increase in bleeding risk with underdosing of LMWH eptifibbatide reflect unmeasured confounders or intentional underdosing of those patients known to be highest risk in the clinical setting. Study additions are displayed in green. Bleeding increased relative to the degree of excess dose and to the number of agents administered in excess 6. Renal insufficiency was determined by a serum creatinine level of more than 2. Interval frequency for LMWH was not collected; therefore, dosing reflects adjustment based on body weight only. August 8,

Remember me on this computer. Point-of-care measured In obese patients undergoing PCI, current eptifibatide platelet inhibition correlates with a reduced risk of an adverse cardiac dosing recommendations may not achieve the target event after percutaneous coronary intervention: results of the GOLD serum concentrations thought necessary to prevent AU-Assessing Ultegra multicenter study. Clinical outcomes are shown in Table 4. Discussion We found that current standard eptifibatide dosing may not provide adequate eptifibatide concentrations in obese patients. Please send your change of address notification at least 6 weeks before your move to ensure continued service.

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Am Heart J. Circulation ; ABW eptifibatide dosing leads to higher steady-state concentrations and greater suppression of teh aggregation than the current standard or IBW dosing regimens. To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.

Relative to national averages, CRUSADE hospitals are larger and more likely to have catheterization laboratories and cardiac surgical capabilities. In addition, the relationship between excess dosing and in-hospital death and length of stay was adjusted for age, sex, race, body mass index calculated as weight in kilograms divided by the square of height in metersrenal insufficiency, cardiac risk factors, prior cardiac history, electrocardiogram changes, positive cardiac markers, signs of CHF, systolic blood pressure, and heart rate at admission. Select two study versions to compare. Study Description Brief Summary: The purpose this study is to assess whether a tirofiban regimen of a high-dose bolus plus a shortened infusion duration compared to label-dosing eptifibatide in patients undergoing percutaneous coronary intervention PCI is associated with a non-inferior composite rate of death, PCI-related myocardial infarction, urgent target vessel revascularization or in-hospital major bleeding within 48 hours following PCI or hospital discharge, whichever comes first. Scroll up to access the controls.

This suggests that safety profiles observed in clinical trials may be attainable in community th with improved dosing eptifibatide dosing in obesity in the united. Purchase access Subscribe now. In addition, information necessary for dosing accuracy may not be available at the time orders are written. Create a free personal account to download free article PDFs, sign up for alerts, customize your interests, and more. Our study further links excess dosing with an increased risk of bleeding even after adjustment for numerous potential confounders.

Am J Cardiol. Eptifibatide pharmacoki- netic-pharmacodynamic relationship in coronary angioplasty cially in light of the small sample size, would have patients: results of the PRIDE study abstract. John Alexander. Full text links Read article at publisher's site DOI : By using the site you are agreeing to this as outlined in our privacy notice and cookie policy.

Lancet used with maximum dosing limits leading to possible ; Information on platelet count, obesuty blockade with high-dose integrilin in coronary intervention: either before or after eptifibatide administration, was not results of the PRIDE study abstract. Table 1 Baseline characteristics. Tcheng JE. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Abciximab: a reappraisal of its use in coronary care.

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Pharmacodynamic study of There are several important limitations to this study. J Clin Invest ; ABW eptifibatide dosing leads to higher steady-state concentrations and greater suppression of platelet aggregation than the current standard or IBW dosing regimens. Standard dosing resulted in a trend toward decreasing plasma concentrations of eptifibatide with increasing patient body weight. Gretler, MD, h and John H.

February 27, Cannon CP. Using general estimating equations, major bleeding was adjusted for key variables known to increase risk of bleeding in an NSTE ACS population eg, age, renal insufficiency, female sex, signs of CHF on admission, and systolic blood pressure. August 8,

Create a free personal account to access your subscriptions, sign up for alerts, and more. Hover over the " Recruitment Status " to see how the study's recruitment status changed. Major Bleeding. Bleeding is financially costly and associated with worse patient outcomes with 3-fold higher mortality demonstrated in a similar NSTE ACS population major bleeding, Attributable Risk.

Frank V. Institutional review board approval was obtained at all centers and all patients gave informed consent prior to participation. Free full text. Conclusions Actual body weight eptifibatide dosing leads to higher plasma concentrations and greater platelet inhibition than standard or IBW dosing in obese patients undergoing PCI. A meta-analysis of N10, patients from 22 studies Steven R.

Create a personal account to register for email alerts with links to free full-text articles. Back to top Article Information. Association of Dosing With Outcomes. Save Preferences.

  • Abstract Background: KILO tested 2 novel weight-based eptifibatide dosing strategies compared with standard dosing in obese patients undergoing elective percutaneous coronary intervention PCI. N Engl J Med.

  • Thus, obese patients may receive additional United States. J Am Coll Cardiol.

  • No other authors reported financial disclosures. Relationship of incorrect dosing of fibrinolytic therapy and clinical outcomes.

  • Integrilin Eptifibatide [package insert]. With more than 1 million patients admitted to US hospitals each year with NSTE ACS, preventing bleeding events in this population would yield substantial health and cost benefits.

This Issue. Underdosing occurred in patients Effect of weight, sex, age, clinical diagnosis, and thromboplastin reagent on steady-state intravenous heparin requirements. A study version is represented by a row in the table. Chen, MS ; Matthew T. August 12, Table 1.

We describe the initial bolus and infusion rates of antithrombotic therapies administered during the first 24 hours to patients with NSTE ACS. This suggests that safety profiles observed in clinical trials may be attainable in community populations with improved dosing accuracy. Bleeding also demonstrates a dose-response with greatest risk among those patients receiving the most excess major excess or multiple agents in excess dose. Study Description Brief Summary:. References Citations:.

Antiplatelet Trialists' Collaboration. This association and other physician variables did not remain significant after adjustment Table 3. For LMWH, patients

In obese patients undergoing PCI, eptifjbatide eptifibatide dosing recommendations may not achieve target serum concentrations thought necessary to prevent ischemic complications. The proportion of patients istration in all groups. Mauricio G. Assessment of Platelet Function Platelet aggregation in response to thrombin activated peptide agonist was assessed prior to administration of the first eptifibatide bolus and 10 minutes after administration of the second bolus. Arnold A .

Standard dosing resulted in a trend toward decreasing plasma concentrations of eptifibatide with increasing patient body weight. The primary endpoint for this study was steady-state plasma eptifibatide concentrations 12—18 hours after the eptifibatide infusion had begun. Frank V. Background KILO tested 2 novel weight-based eptifibatide dosing strategies compared with standard dosing in obese patients undergoing elective percutaneous coronary intervention PCI. By design, detailed information on baseline characteristics, co-morbidities and concomitant medications was not collected.

Alexander JH. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. Download PDF. Am Heart J4 :e23; author reply e25, 13 Mar Likewise, for unfractionated heparin, weight-based dosing nomograms are often used with maximum dosing limits leading to possible under-dosing in morbidly obese patients. The not so "ideal" body weight-based dosing of Integrilin in obesity. Clin Ther ;

Purchase access Subscribe to JN Learning for one year. Choose either the "Merged" or "Side-by-Side" comparison format to specify how the two study versions are to be displayed. No other authors reported financial disclosures. Committee on Quality of Health Care in America.

February 27, CRUSADE hospitals voluntarily participate in this national quality eptifibatide dosing in obesity in the united initiative; therefore, their focus on quality may actually underestimate the magnitude of excessive dosing in general community practice. Recommended antithrombotic dose was defined in accordance with package inserts, guidelines, and clinical trial publications Table 1. The interesting increase in bleeding risk with underdosing of LMWH may reflect unmeasured confounders or intentional underdosing of those patients known to be highest risk in the clinical setting. The composite incidence of death, PCI-related myocardial infarction or urgent target vessel revascularization [Time Frame: 48 hours]. Patients receiving excess antithrombotic therapy also had higher mortality and longer length of stays.

Author Contributions: Dr Alexander had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. August 12, The majority of excess dosing was mild in degree, but a small proportion of patients were administered doses far above the recommended range major excess. Importantly, we demonstrated that after adjusting for patient factors, dosing errors remain associated with increased bleeding, particularly when multiple agents are administered in excess.

  • Race was collected as reported in the medical record white, black, Asian, Pacific Islander, American Indian, or other. J Am Coll Cardiol.

  • N Engl J Med ; Discussion We found that current standard eptifibatide dosing may not provide adequate eptifibatide concentrations in obese patients.

  • Bleeding increased relative to the degree of excess dose and to the number of agents administered in excess 6. We investigated patient and physician factors associated with excess dosing for each therapy by using multivariable analysis with the generalized estimating equations method to adjust for associations within clustered responses eg, within hospital associations.

  • Despite higher plasma concentrations of eptifibatide in the ABW dosing group, no increase in bleeding was observed.

PAU, Platelet aggregation unit. Am J excluded. Address for correspondence: John H. Patients above this weight receive the same maximal dose, although it is unknown if this provides adequate eptifibatide concentration or platelet inhibition. By design, detailed information on baseline characteristics, co-morbidities and concomitant medications was not collected. Open in a separate window. Author manuscript; available in PMC Mar

Keywords: antibiotic; antimicrobial; critically ill; dosing; obesity; pharmacokinetics. Platelet aggregation was tested using only 1 Cardiol ; Alternatively, since eptifibatide has a limited volume of distribution and does not distribute well into doxing tissue, obese patients may be better suited with lower, ideal body weight IBW -adjusted dosing. Many patients who undergo PCI weigh N kg. A total of 1. Table 2 Eptifibatide dosing, plasma concentrations and pre- and post-drug platelet aggregation units. The relationships between Results patient weight and eptifibatide concentration, dosing regi- A total of 67 patients were enrolled: 22 in the standard mens and concentrations, and the differential effect of dosing dosing group, 23 in the ABW dosing group, and 22 in the regimen across increasing weight were compared using analysis of covariance ANCOVA models for concentration IBW dosing group.

The composite incidence of death, PCI-related myocardial infarction, urgent target vessel revascularization or major bleeding [Time Frame: 48 hours]. Create a free personal account to download free article PDFs, sign up for alerts, and more. Changing the model of care for patients with acute coronary syndromes: implementing practice guidelines and altering physician behavior. Pharmacokinetic and pharmacodynamic properties of eptifibatide in subjects with normal or impaired renal function.

It is possible that the use of another assay may yield different results. A meta-analysis of N10, patients from 22 studies Steven R. Abstract Physiologic alterations seen in obesity commonly impact the pharmacokinetics PK and pharmacodynamics PD of antibiotics and may result in suboptimal dosing in this expanding but understudied population. Free to read.

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Figure 1. N Engl J Med. National Institutes of Health U. An excess dose was administered to patients Hypertension was on by a patient having a systolic blood pressure of more than mm Hg, diastolic blood pressure of more than 90 mm Hg on repeated measurements, or hypertension chronically treated with antihypertensive medications. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue.

Numbers provided are the individuals receiving treatment with available dose information in each age group. Continuous variables are reported as medians and interquartile ranges or mean SDand categorical variables are reported as number percentage. Create a free personal account to access your subscriptions, sign up for alerts, and more. Relative to national averages, CRUSADE hospitals are larger and more likely to have catheterization laboratories and cardiac surgical capabilities.

Effect of weight, sex, age, clinical diagnosis, and thromboplastin reagent on steady-state intravenous heparin requirements. After adjustment, those patients receiving excess doses of UFH demonstrated a slight trend to increased bleeding odds ratio [OR], 1. Original Contribution. Tirofiban [package insert].

Am J Cardiol88 1001 Nov Eptifibatide dosing, plasma concentrations and pre- and post-drug platelet aggregation units. Unfractionated heparin was administered as needed to attain the recommended target activated clotting time of — seconds. Click here to sign up. PAU, Platelet aggregation unit. David E.

The composite incidence of death, PCI-related myocardial infarction, urgent target vessel revascularization or major bleeding [Time Frame: 48 hours] Secondary Outcome Measures: 2. Cannon CP. Our primary goal was to compare outcomes in patients receiving excess doses compared with no excess dose. Interestingly, we found an association between errors of omission failure to give recommended therapies and errors of commission dosing errors at the hospital level. Committee on Quality of Health Care in America. Citations

The appropriate dosing of antithrombotics in obese patients has been poorly studied. Clinical findings through hospital discharge. Frank V. Platelet aggregation was tested using only one type of device. Susanna Stevens.

Address for correspondence: John H. Much of the published clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogeneous results that in some cases are contradictory. Serial platelet aggregation assessments, espe- 7. Figure 1.

The median infusion rate was variables and as frequencies with their respective percentages Download pdf. Am J excluded. Table 2 Eptifibatide dosing, plasma concentrations and pre- and post-drug platelet aggregation units. The publisher's final edited version of this article is available at Am Heart J. In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults. Rapid platelet-function bolus administration during percutaneous coronary revascularization assay: an automated and quantitative cartridge-based method.

Create a free personal account to make a comment, download free article PDFs, sign up for alerts and more. Institutional sign in: OpenAthens Shibboleth. A number of patients also received initial antithrombotic therapy at doses lower than recommended. Eligibility Minimum Age:.

Figure 1. Association of Dosing With Outcomes. The purpose this study is to assess whether a tirofiban regimen of a high-dose bolus plus a shortened infusion duration compared to label-dosing eptifibatide in patients undergoing percutaneous coronary intervention PCI is associated with a non-inferior composite rate of death, PCI-related myocardial infarction, urgent target vessel revascularization or in-hospital major bleeding within 48 hours following PCI or hospital discharge, whichever comes first.

Click "Compare" to do the comparison and show the differences. Eptifibatide dosing in obesity in the united occurred in patients The composite incidence of death, PCI-related myocardial infarction or urgent target vessel revascularization [Time Frame: 48 hours]. Predictors of Excess Dose. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Creatinine clearance was estimated from age, sex, creatinine, and body weight as recorded on the case report form by using the formula of Cockcroft-Gault.

David E. In the presence of a statistically Novel dosing regimen of eptifibatide in planned coronary stent nated heparin, weight-based dosing nomograms are often implantation ESPRIT : a randomised, placebo-controlled trial. Need an account? Skip to main content. However, ABW dosing provides increased plasma concentrations with increas- ing weight leading to potential overdosing in the heaviest patients.

Increases in major bleeding occurred in patients Figure 2. The expanding array of therapies coupled with the aging population makes attention to dosing an immediate priority for safe NSTE ACS care. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. Changing the model of care for patients with acute coronary syndromes: implementing practice guidelines and altering physician behavior.

A review. Publication types Review. Most of the patients were women, and that included weight, dosing regimen, and the weight-by- the median 25th, 75th percentile weight was kg dosing regimen interaction.

Study Limitations. January 30, The cut points for tne and major excess were selected for demonstration purposes only, and dosing risk is likely to increase along a continuum. None of the sponsors played a role in conducting the analysis or in interpreting or reporting the results. Race was collected as reported in the medical record white, black, Asian, Pacific Islander, American Indian, or other. Although it is not possible to firmly establish a causal link between excess dosing and major bleeding in an observational study, we estimated the potential impact of dose-associated bleeding in our population as follows. Create a free personal account to make a comment, download free article PDFs, sign up for alerts and more.

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Log In Sign Up. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been dozing for publication. Am J excluded. The appropriate dosing of antithrombotics in obese Funding source: The KILO trial was funded by a grant patients has been poorly studied. As expected, higher concentrations were associated with higher doses of eptifibatide.

Sign in to download free article PDFs Sign in to access your subscriptions Sign in to eptifibatdie personal account. Table 1. Enoxaparin [package insert]. Further study is warranted to define the optimal dosing of eptifibatide and other medications in obesity patients. Study Design Study Type:. Subsequent dosing adjustments made after the initial dose were delivered or alterations in dosing interval for LMWH were not considered. In addition, the relationship between excess dosing and in-hospital death and length of stay was adjusted for age, sex, race, body mass index calculated as weight in kilograms divided by the square of height in metersrenal insufficiency, cardiac risk factors, prior cardiac history, electrocardiogram changes, positive cardiac markers, signs of CHF, systolic blood pressure, and heart rate at admission.

Select two study versions to compare. J Am Coll Cardiol. Author Contributions: Dr Alexander had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Major bleeding occurred in No other authors reported financial disclosures.

  • For UFH, patients The relative increase in bleeding with excess dosing rate of bleeding in patients receiving excess dose minus rate of bleeding in those not dosed excessively was applied to the total number of patients receiving excess doses of each agent to arrive at the incremental dose-associated bleeding.

  • Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults.

  • Author Contributions: Dr Alexander had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Continuous variables are reported as medians and interquartile ranges or mean SDand categorical variables are reported as number percentage.

Pre-drug median platelet aggregation units werein the standard dosing group,in the ABW dosing group, andin the IBW dosing group Table 2. Randomization eptifibatide dosing in obesity in the united Treatment Patients were enrolled in this prospective randomized single-blind clinical trial at 5 participating centers in the United States. Arnold A. Values presented as median 25th, 75th. Assessment of Platelet Function Platelet aggregation in response to thrombin activated peptide agonist was assessed prior to administration of the first eptifibatide bolus and 10 minutes after administration of the second bolus. J Invasive Cardiol ;

  • February 6, Table 2.

  • Cited by: 6 articles PMID: Aguirre, MD, g Daniel D.

  • In addition, the relationship between excess dosing and unitde death and length of stay was adjusted for age, sex, race, body mass index calculated as weight in kilograms divided by the square of height in metersrenal insufficiency, cardiac risk factors, prior cardiac history, electrocardiogram changes, positive cardiac markers, signs of CHF, systolic blood pressure, and heart rate at admission. Click "Compare" to do the comparison and show the differences.

  • Effects of computerized physician order entry on prescribing practices.

Basel, Switzerland: Karger; Plasma eptifibatide concentrations were drawn at 12 to 18 hours after initiating the infusion. Using general estimating equations, major bleeding was adjusted for key variables known to increase risk of bleeding in an NSTE ACS population eg, age, renal insufficiency, female sex, signs of CHF on admission, and systolic blood pressure. Table 3 shows the adjusted predictors of excess dosing. Effects of computerized physician order entry on prescribing practices. Relationship of incorrect dosing of fibrinolytic therapy and clinical outcomes. This association and other physician variables did not remain significant after adjustment Table 3.

The appropriate dosing of antithrombotics in obese patients has been poorly studied. Am J excluded. Novel dosing regimen of eptifibatide in planned coronary stent nated heparin, weight-based dosing nomograms are often implantation ESPRIT : a randomised, placebo-controlled trial. By Michael Kitt.

One patient with weight of kg second bolus of eptifibatide. A scatterplot of concentration by weight in the standard dosing group,in the with the 3 regression lines for each dosing regimen based on ABW dosing group, andin the IBW dosing the ANCOVA model is presented Figure 1. As expected, higher concentrations were associated with higher doses of eptifibatide.

Clinical eptifkbatide are shown in Table 4. There are several important limitations to this study. Download Free PDF. As expected, higher concentrations were associated with higher doses of eptifibatide. Lancet ; ABW eptifibatide dosing leads to higher steady-state concentrations and greater suppression of platelet aggregation than the current standard or IBW dosing regimens. BMI, Body mass index.

Subsequent dosing adjustments made after the initial dose were delivered or alterations in dosing interval doskng LMWH were not considered. Select a version's Submitted Date link to see a eptifibatide dosing in obesity in the united of the study for that version. Secondary analyses also explored the relationship between the magnitude of excess dose and multiple agents dosed in excess. Numbers provided are the individuals receiving treatment in each dose group who did not undergo coronary artery bypass grafting or transfer hospital after arrival. After adjustment, when both were administered in excess, the risk for major bleeding increased 2-fold OR, 1. Table 2. April 6,

These factors, obesity anything, would lead rosing an underestimation of dosing errors as well as their association with adverse clinical outcomes. Factors associated with excess dosing included older age, as well as female sex, renal insufficiency, low body weight, diabetes mellitus, and congestive heart failure. In acute coronary syndromes ACSearly use of antiplatelet and antithrombin therapy plays a key role in altering the thrombotic process resulting from plaque rupture, thereby improving patient outcomes. Recommended antithrombotic dose was defined in accordance with package inserts, guidelines, and clinical trial publications Table 1. Blood transfusion costs by diagnosis-related groups in 60 university hospitals in

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