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Publications (3)6.57 Total impact

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    ABSTRACT: The use of a weight-based nomogram is considered standard care for prescribing appropriate doses of unfractionated heparin (UFH). Because of the need for multiple other medications that may affect bleeding and that clinical data have relied on similar dosing algorithms, maximum initial bolus and infusion rates have been suggested (capped initial dose). Whether these weight-based heparin nomograms properly address therapeutic dosing in obese patients remains questionable. We retrospectively compared 30 patients treated for acute coronary syndrome and weighing ò 110 kg with 90 controls (3 groups of 30 patients, weighting 50-69.9, 70-89.9 or 90-109.9 kg), all treated with UFH, July 2008 to April 2009. The primary end point was the time required to obtain a threshold activated partial thromboplastin time (aPTT). Mean time to achieve threshold aPTT was longer for obese patients weighing ò 110 kg than for controls (31.47 vs. 12.89 hours; p<0.0001). At 24 hours, 63% of obese patients weighing ò 110 kg had not reached threshold aPTT vs. 7% of controls (p<0.0001). However, threshold infusion rate did not differ between weight categories (13.0 vs. 13.1 U/kg/h; p=NS) and approximated the initial infusion rate recommended by nomograms without applying the dose cap (12 U/kg/h). We conclude that adequate anticoagulation time doubled in patients weighing ò 110 kg, suggesting that these patients are not receiving initially appropriate heparin doses to achieve threshold aPTT rapidly. Our study suggests that using initial infusion rate recommended by a nomogram without capping for total body weight may be acceptable. This approach should be further evaluated in a prospective study.
    Obesity 09/2012; · 3.92 Impact Factor
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    ABSTRACT: To examine the association between weight gain since menopause and weight regain after a weight loss program. Participants were 19 obese women who participated in a 15-week weight loss program and a 12-month follow-up. Main outcomes were: body composition, resting metabolic rate, energy intake, energy expenditure, and weight regain at follow-up. All body composition measures significantly decreased after intervention (all P ≤ 0.01) while all measures of fatness increased significantly after the 12-month follow-up (P ≤ 0.01). Body weight gain since menopause was associated with body weight regain (r = 0.65; P = 0.003) after follow-up even after adjustment for confounders. Weight gain since menopause is associated with body weight regain following the weight loss program. Therefore, weight gain since menopause should be considered as a factor influencing weight loss maintenance in older women.
    Clinical Interventions in Aging 01/2011; 6:221-5. · 2.65 Impact Factor
  • Ardilouze JL