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Predictors of Heparin Resistance Before Cardiovascular Operations in Adults.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2018 May; Vol. 105 (5), pp. 1316-1321. Date of Electronic Publication: 2018 Apr 06. - Publication Year :
- 2018
-
Abstract
- Background: Heparin resistance (HR) is often encountered during cardiovascular operations that require cardiopulmonary bypass. Clinical risk factors and the mechanism underlying heparin resistance are yet to be determined. The aim of this study was to elucidate the clinically valid preoperative predictors related to HR.<br />Methods: The study evaluated 489 patients undergoing cardiovascular operations. Of these, 25 patients presented with HR and received antithrombin III for the initiation of cardiopulmonary bypass with an effective activated coagulation time. The remaining 464 patients, who did not receive antithrombin III, served as controls (NHR). Preoperative patient demographic and laboratory data were analyzed to identify risk factors for HR.<br />Results: The preoperative laboratory data showed platelet count, fibrinogen, D-dimer, creatinine, and C-reactive protein were significantly higher in the HR group than in the NHR group. As expected, the antithrombin III level was significantly lower overall in the HR group (86.0% vs 95.5%, p = 0.009); however, 80% of the patients in the HR group showed normal antithrombin III levels preoperatively. Multivariable logistic regression analysis identified chronic aortic dissection, chronic obstructive pulmonary disease, smoking, and elevated fibrinogen levels as independent predictors for HR.<br />Conclusions: HR was shown to be associated with preoperative high fibrinogen levels, a smoking habit, and a preoperative diagnosis of chronic, but not acute, aortic dissection, with chronic obstructive pulmonary disease as comorbidity. Administration of antithrombin III resolved HR in all of the affected patients, even when their preoperative antithrombin III level was within the normal limit.<br /> (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aortic Dissection epidemiology
Antithrombin III therapeutic use
Case-Control Studies
Female
Fibrinogen metabolism
Heparin
Humans
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive epidemiology
Risk Factors
Smoking adverse effects
Anticoagulants pharmacology
Cardiopulmonary Bypass
Drug Resistance
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 105
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 29501637
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2018.01.068