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Heparin resistance management during cardiac surgery: a literature review and future directions

Authors :
Butt Salman Pervaiz
Kakar Vivek
Kumar Arun
Razzaq Nabeel
Saleem Yasir
Ali Babar
Raposo Nuno
Ashiq Fazil
Ghori Arshad
Anderson Philip
Srivatav Nilesh
Aljabery Yazan
Abdulaziz Salman
Darr Umer
Bhatnagar Gopal
Source :
The Journal of ExtraCorporeal Technology, Vol 56, Iss 3, Pp 136-144 (2024)
Publication Year :
2024
Publisher :
EDP Sciences, 2024.

Abstract

Introduction: Heparin, a commonly used anticoagulant in cardiac surgery, binds to antithrombin III (ATIII) to prevent clot formation. However, heparin resistance (HR) can complicate surgical procedures, leading to increased thromboembolic risks and bleeding complications. Proper diagnosis and management of HR are essential for optimizing surgical outcomes. Methodology: Diagnosis of HR involves assessing activated clotting time (ACT) and HR assays. Management strategies were identified through a comprehensive review of the literature, including studies exploring heparin dosage adjustments, antithrombin supplementation, and alternative anticoagulants in cardiac surgery patients with HR. A thorough search of relevant studies on HR was conducted using multiple scholarly databases and relevant keywords, resulting in 59 studies that met the inclusion criteria. Discussion: HR occurs when patients do not respond adequately to heparin therapy, requiring higher doses or alternative anticoagulants. Mechanisms of HR include AT III deficiency, PF4 interference, and accelerated heparin clearance. Diagnosis involves assessing ACT and HR assays. HR in cardiac surgery can lead to thromboembolic events, increased bleeding, prolonged hospital stays, and elevated healthcare costs. Management strategies include adjusting heparin dosage, supplementing antithrombin levels, and considering alternative anticoagulants. Multidisciplinary management of HR involves collaboration among various specialities. Strategies include additional heparin doses, fresh frozen plasma (FFP) administration, and antithrombin concentrate supplementation. Emerging alternatives to heparin, such as direct thrombin inhibitors and nafamostat mesilate, are also being explored. Conclusion: Optimizing the management of HR is crucial for improving surgical outcomes and reducing complications in cardiac surgery patients. Multidisciplinary approaches and emerging anticoagulation strategies hold promise for addressing this challenge effectively.

Details

Language :
English
ISSN :
00221058 and 29698960
Volume :
56
Issue :
3
Database :
Directory of Open Access Journals
Journal :
The Journal of ExtraCorporeal Technology
Publication Type :
Academic Journal
Accession number :
edsdoj.527a6f8495d14906af5d949489e6b157
Document Type :
article
Full Text :
https://doi.org/10.1051/ject/2024015