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Heparin resistance and the potential impact on maintenance of therapeutic coagulation

Published online by Cambridge University Press:  01 June 2007

G. J. Despotis ,
M. Avidan  and
J. H. Levy
G. J. Despotis*
Affiliation:
Washington University School of Medicine, Department of Pathology, Immunology and Anesthesiology, St. Louis, MO, USA Washington University School of Medicine, Department of Anesthesiology and Surgery, St. Louis, MO, USA
M. Avidan
Affiliation:
Washington University School of Medicine, Department of Anesthesiology and Surgery, St. Louis, MO, USA
J. H. Levy
Affiliation:
Emory University School of Medicine, Department of Anesthesiology, Atlanta, GA, USA
*
Correspondence to: George Despotis, Department of Pathology and Immunology, Box 8118, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Mo. 63110, USA. E-mail: gdespotis@path.wustl.edu; Tel: +(314) 362 6584; Fax: +(314) 362 1461
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Summary

Background and objectives

The main aim of this review is to summarize the literature with respect to the impact of anticoagulation monitoring strategies and therapeutic strategies to manage heparin resistance and optimize anticoagulation with cardiac surgery.

Methods

This review was generated using peer-reviewed manuscripts pertinent to this topic that were identified using a computer-based Medline search.

Results

There are a small number of well-controlled prospective, randomized studies, some of which suggest that bleeding and transfusion can be attenuated by refining heparin monitoring techniques by sustaining better anticoagulation during cardiopulmonary bypass especially when applied to operative cases that involve complex procedures that require long intervals on cardiopulmonary bypass. Recent studies indicate that antithrombin III concentrates can be used to treat heparin resistance and thereby enhance preservation of the hemostatic system during CPB. A few recent retrospective analyses suggest that low ATIII concentration is associated with negative outcomes.

Conclusions

The literature indicates that enhanced anticoagulation via more sophisticated heparin monitoring schemes can reduce bleeding and transfusion and that antithrombin III concentrates can be used to effectively manage heparin resistance during cardiac surgery. Well-controlled, randomized studies are needed to better define the relative importance of AT IIII supplementation with respect to either the management of heparin resistance or with respect to optimization of anticoagulation during CPB and specifically if these interventions are able to decrease the incidence of bleeding and/or thrombotic complications.

Keywords

AnticoagulationCardiac surgeryHeparin resistanceHemostatic systemHerapinAntithrombinBleedingDisseminated intravascular consumption
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue S40 , June 2007 , pp. 37 - 58
Copyright
Copyright © European Society of Anaesthesiology 2007

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