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Excessive requirement for heparin during cardiac surgery
Canadian Anaesthetists' Society Journal
|May 1, 1981
Summary
A patient with sepsis required a high dose of heparin during cardiopulmonary bypass due to an unknown cause. This case highlights potential factors influencing heparin efficacy in complex medical scenarios.
Area of Science:
- Cardiology
- Hematology
- Critical Care Medicine
Background:
- Cardiopulmonary bypass (CPB) requires anticoagulation, typically with heparin, to prevent thrombosis.
- Maintaining adequate anticoagulation during CPB can be challenging in patients with specific comorbidities.
Observation:
- A patient with sepsis secondary to a myocardial abscess presented with an unusually high heparin requirement during CPB.
- The patient needed 13.5 mg/kg of heparin to achieve therapeutic activated coagulation time (ACT).
Findings:
- The excessive heparin requirement suggests potential underlying conditions affecting coagulation.
- Possible contributing factors include individual variability, lupus vasculitis, sepsis, recurrent thromboembolic events, or chronic disseminated intravascular coagulation with partial antithrombin deficiency.
Implications:
- This case underscores the importance of vigilant monitoring of anticoagulation in complex CPB cases.
- Further investigation into the specific cause of heparin resistance is crucial for optimizing patient management and preventing complications.