Heparin Resistance - A Reality or Fallacy

The term heparin resistance is often used by clinicians, despite the lack of specific criteria. Defining true heparin resistance remains problematic in both adults and pediatrics, as there is no consensus on a "maximum" heparin dose. Furthermore, the indication or setting of heparin use may impact perceptions of what is considered a maximum dose. For example, what might be considered a normal dose in the setting of cardiac surgery might be considered "high" in the intensive care unit. There is also a mixed opinion as to the ideal monitoring strategy. Given the lack of a standardized definition and the misunderstandings that exist surrounding the topic of heparin resistance, this review serves to provide insights into heparin resistance in pediatric patients and potential management strategies.