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Different patterns of heparin resistance: therapeutic implications
Marco Ranucci1, Giuseppe Isgrò, Anna Cazzaniga
1Department of Cardiothoracic Anaesthesia, Cardiovascular Centre E. Malan, University of Milan, Istituto Policlinico S. Donato, Italy. m.ranucci@galactica.it
Perfusion
|May 23, 2002
Summary
Heparin resistance (HR) in cardiac surgery can occur independently of antithrombin III (AT III) levels. A subgroup of patients with normal AT III shows unique HR characteristics and does not respond to AT III supplementation.
Area of Science:
- Cardiology
- Anesthesiology
- Hematology
Background:
- Heparin resistance (HR) is a frequent complication during cardiac surgery.
- Decreased antithrombin III (AT III) levels, often due to preoperative heparin, are a common cause of HR.
- Some patients exhibit HR despite normal AT III levels, suggesting alternative mechanisms.
Purpose of the Study:
- To identify and characterize patients with AT III-independent heparin resistance.
- To differentiate this subgroup from AT III-dependent heparin resistance.
Main Methods:
- Prospective trial involving 500 consecutive patients undergoing coronary revascularization with cardiopulmonary bypass.
- Identification of HR based on clinical criteria.
- Measurement of preoperative antithrombin III (AT III) activity.
Main Results:
- Heparin resistance (HR) was observed in 20.8% of patients.
- A distinct subgroup of 7.2% of patients exhibited AT III-independent HR (preoperative AT III activity ≥ 100%).
- This subgroup presented with less severe HR, lower rates of prior heparin treatment, and no response to AT III supplementation.
Conclusions:
- A significant subgroup of patients experiences AT III-independent heparin resistance during cardiac operations.
- These patients do not benefit from standard AT III supplementation strategies.
- Further research is needed to elucidate the mechanisms and optimal management of AT III-independent HR.