Heparin Sensitivity and Resistance: Management During Cardiopulmonary Bypass

@article{Finley2013HeparinSA,
  title={Heparin Sensitivity and Resistance: Management During Cardiopulmonary Bypass},
  author={Alan C. Finley and Charles S. Greenberg},
  journal={Anesthesia \& Analgesia},
  year={2013},
  volume={116},
  pages={1210–1222}
}
Heparin resistance during cardiac surgery is defined as the inability of an adequate heparin dose to increase the activated clotting time (ACT) to the desired level. Failure to attain the target ACT raises concerns that the patient is not fully anticoagulated and initiating cardiopulmonary bypass may result in excessive activation of the hemostatic system. Although antithrombin deficiency has generally been thought to be the primary mechanism of heparin resistance, the reasons for heparin… Expand

Paper Mentions

Interventional Clinical Trial
Aim of the ACTION-1 study is to determine whether ACT guided heparinization decreases thrombo-embolic complications (TEC) and mortality after elective open AAA surgery, without… Expand
ConditionsAbdominal Aortic Aneurysm, Arterial Disease, Surgery
InterventionDrug
Observational Patient Registry Clinical Trial
Aim of the MANCO study is to establish for once and for all that monitoring the effect of heparin during NCVI (Non-Cardiac Vascular Interventions) is essential to ensure the… Expand
ConditionsArterial Disease, Peripheral Arterial Disease, PTA, (+1 more)
InterventionOther
Bivalirudin as an adjunctive anticoagulant to heparin in the treatment of heparin resistance during cardiopulmonary bypass-assisted cardiac surgery
TLDR
The favorable outcome of the single-center experience with the alternative use of bivalirudin in the management of anticoagulation of heparin unresponsive patients undergoing coronary artery bypass graft surgery is reported. Expand
Heparin Sensitivity and Resistance: Management During Cardiopulmonary Bypass
TLDR
The target ACT is chosen that is believed to be sufficiently more than the minimal ACT, below which subtherapeutic anticoagulation occurs and interventions aimed at achieving the target ACT and providing an adequate margin of safety in regards to antICOagulation are proposed. Expand
Factors associated with errors in the heparin dose response test: recommendations to improve individualized heparin management in cardiopulmonary bypass
TLDR
A retrospective study of 250 patients who underwent cardiac surgery found that individualized heparin bolus by HDR test is consistently underestimated while it gave a significant number of positive and negative errors. Expand
Individual Differences in Heparin Sensitivity and Their Effect on Heparin Anticoagulation During Arterial Vascular Surgery.
  • D. Veerhoek, F. Groepenhoff, +5 authors C. Vermeulen
  • Medicine
  • European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
  • 2017
TLDR
This study shows that a third of the study population had reduced heparin sensitivity, which was associated with lower levels ofHeparinisation, and lower inhibition levels of clot initiation and clot formation. Expand
Predictors of Heparin Resistance Before Cardiovascular Operations in Adults.
TLDR
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. Expand
Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation.
TLDR
Large prospective multicenter trials are urgently needed to investigate the optimal anticoagulation management strategy during ECMO support, because of the major intra- and inter-institutional variability observed. Expand
No Concluding Evidence on Optimal Activated Clotting Time for Non-cardiac Arterial Procedures.
TLDR
A lack of data and no consensus in the literature concerning the optimal ACT, and the possible association with haemorrhagic complications and ATEC during NCAP are demonstrated. Expand
Massive atrial myxoma requiring emergency cardiopulmonary bypass in a patient with heparin resistance
TLDR
Successful cardiopulmonary bypass was achieved with additional heparin boluses from an alternative batch administered both intravenously and via the bypass circuit, and it is advocated that consideration of this approach as one possible solution to achieving safe entry onto cardiopULmonary bypass in a crisis scenario is recommended. Expand
Changes in heparin dose response slope during cardiac surgery: possible result in inaccuracy in predicting heparin bolus dose requirement to achieve target ACT
TLDR
It can be hypothesized that the wide discrepancy in HDR slope versus heparin sensitivity may be explained by an inaccurate prediction of the plasma hepar in level and/or the change in HDR of individual patients, depending on in vivo factors such as extravascular sequestration of heparIn, decreased intrinsic antithrombin activity level and platelet count and/ or activity. Expand
Identifying optimal heparin management during cardiopulmonary bypass in obese patients: A prospective observational comparative study
TLDR
The standardHeparin regimen based on TBW in obese patients during CPB results in excessive plasma heparin concentrations and a significant intraoperative decrease in haemoglobin concentration. Expand
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 170 REFERENCES
Anticoagulation management during cardiopulmonary bypass: a survey of 54 North American institutions.
TLDR
In clinical practice inhibiting thrombin formation/activity during CPB is essential to minimizing overt thrombosis, the clinical consequences of a consumptive coagulopathy, or both. Expand
Heparin resistance during cardiopulmonary bypass. The role of heparin pretreatment.
TLDR
Patients receiving heparin treatment preoperatively for cardiopulmonary bypass would be at high risk for inadequate anticoagulation during CPB and would be prone to potentially lethal hemorrhagic and thrombotic sequelae. Expand
Management of heparin resistance during cardiopulmonary bypass: the effect of five different anticoagulation strategies on hemostatic activation.
TLDR
Activation of hemostasis during CPB in heparin-resistant patients most likely has to be attributed to stimulation of the tissue factor pathway and anticoagulation duringCPB with UFH should be supplemented with either AT III, a short-acting direct thrombin inhibitor, or a long-acting platelet glycoprotein IIb/IIIa antagonist. Expand
Preoperative low molecular weight heparin reduces heparin responsiveness during cardiac surgery
TLDR
Prolonged preoperative LMWH therapy, similar to the known effect of prolonged unfractionated heparin infusion, reduces subsequent intraoperative response to heparins during cardiac surgery. Expand
Heparin pretreatment does not alter heparin requirements during cardiopulmonary bypass.
TLDR
Despite ACTs of less than 400 s in both groups, no coagulation was seen, suggesting that 300 IU kg(-1) heparin is a safe dose for anticoagulation in CPB even after heparIn therapy. Expand
Low activated coagulation time during cardiopulmonary bypass does not increase postoperative bleeding.
TLDR
It is concluded that a minimum ACT value for adequacy of heparinization is not yet defined but that it is less than 400 seconds. Expand
Monitoring heparin anticoagulation in the acute phase response
TLDR
Thromboelastographic and thrombin generation parameters concurred with APTT, demonstrating a genuine heparin resistance in the presence of high FVIII levels, suggesting that APTT may be a more accurate measure of anticoagulant effect in vivo than anti‐Xa. Expand
Heparin management protocol for cardiopulmonary bypass influences postoperative heparin rebound but not bleeding.
A group of 63 adult patients undergoing cardiac surgical procedures requiring cardiopulmonary bypass (CPB) were studied to examine the relationship between heparin doses administered andExpand
Laboratory heparin resistance in burn injury complicated by venous thrombosis.
TLDR
Physicians treating patients with burn injury complicated by venous thrombosis should be aware of the potential development of factor VIII-related heparin resistance when large amounts ofHeparin are required to obtain a satisfactory elevation in the APTT. Expand
Heparin Concentration–Based Anticoagulation for Cardiac Surgery Fails to Reliably Predict Heparin Bolus Dose Requirements
TLDR
The Hepcon HMS Plus system poorly estimates heparin bolus requirements in the pre-CPB period and how clinicians can reliably and practically assess anticoagulation in the operating room is questioned. Expand
...
1
2
3
4
5
...