A few questions I had about heparin in CHF patients:
1. With weight-based LMHW heparin dosing, do you use the patient's actual weight, or their pre-admission "dry weight" (if they are in CHF with significant edema?).
Seriously though, it probably doesn't matter. Even with a fairly significant weight gain of 20% you would only be giving them a 20% larger dose. Medication dosing is just not that exact.
If you use ideal body weight with fractionated heparins, you will be underdosing. Generally, you won't make a hugh change in dosing with the weight changes in CHF patients. With unfractionated heparin, I use current weight as a start because further dosing is based on PT. Maybe a pharmacist can answer this for you, but I don't think it makes a big difference.
This is kind of funny b/c in some area of the country where the population is uhhh.....larger......we have to limit the LMWH....No scientific data on patients 130kg etc....so we generally limit the dose at 150mg BID when they exceed the recommended safety dosages based on weight.
