Anticoagulation Management and Heparin Resistance During Cardiopulmonary Bypass: A Survey of Society of Cardiovascular Anesthesiologists Members

Sniecinski, Roman M.; Bennett‐Guerrero, Elliott; Shore‐Lesserson, Linda

doi:10.1213/ane.0000000000003981

Cited by 30 publications

(32 citation statements)

References 6 publications

(14 reference statements)

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“…The advantages of the HMS Plus are as follows: (1) it can be used at the bedside for point-of-care testing, and (2) it can detect inadequate anticoagulation (heparin concentrations below than 3 U/mL during CPB) despite a prolonged ACT. However, the survey of members of the Society of Cardiovascular Anesthesiologists in 2017 demonstrated that only 13.1% of institutions answered that they used heparin concentration to determine adequate anticoagulation for CPB [ 9 ]. This result suggested that heparin concentration measurement devices such as the HMS Plus are not currently available in the majority of institutions providing cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Correlation between activated clotting time monitoring and heparin concentration measurement in a patient with antiphospholipid syndrome during cardiac valve surgery: a case report

et al. 2021

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Background Anticoagulation management of patients with antiphospholipid syndrome (APS) undergoing cardiac surgery is challenging due to the prolongation of activated clotting time (ACT). Currently, no study has compared the utility of ACT monitoring using the Hemochron Jr. Signature+ and that of heparin concentration management using the Hemostasis Management System (HMS) Plus in patients with APS. Case presentation A 71-year-old woman with APS was scheduled to undergo an aortic valve replacement for aortic regurgitation. The ACT was measured using the Hemochron Jr. Signature+, and the heparin concentration was measured concurrently using the HMS Plus. ACT over 480 s corresponded to an adequate heparin concentration during cardiopulmonary bypass. The clinical course was uneventful, and no thrombotic or hemorrhagic complications were observed. Conclusion In the present patient with APS, the Hemochron Jr. Signature+ was useful as an anticoagulation management during cardiac valve surgery.

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Section: Discussionmentioning

confidence: 99%

Correlation between activated clotting time monitoring and heparin concentration measurement in a patient with antiphospholipid syndrome during cardiac valve surgery: a case report

et al. 2021

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“…Therefore, women with HR need to take more heparin to prevent thrombosis. 18 HR might be regarded as a state of response to a variable dose of heparin. Therefore, a combination of supplementary LMWH, FFP, or AT concentrate is usually recommended.…”

Section: Discussionmentioning

confidence: 99%

Management of heparin resistance due to antithrombin deficiency in a Chinese pregnant woman: a case report

et al. 2021

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Untreated individuals with antithrombin (AT) deficiency are at higher risk of thrombosis and adverse pregnancy outcomes. The present recommendations are mostly empirical for treating patients with AT deficiency during pregnancy because of the absence of guidelines. We report a rare case of heparin resistance due to AT deficiency in a pregnant 32-year-old Chinese woman. We also reviewed the English medical literature for AT deficiency and its association with thromboembolism and treatment. This patient suffered two early miscarriages because of thrombosis due to AT deficiency. The patient was administered the combination of adequate low molecular weight heparin with fresh frozen plasma and warfarin because of her heparin resistance. She delivered a healthy female newborn without any adverse effects of the anticoagulation therapy. Our findings suggest that the combination of adequate low molecular weight heparin with fresh frozen plasma and warfarin is effective for preventing thrombus during pregnancy.

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“…Additionally, laboratory testing is not universally available and takes 30- There is a lack of consensus on a suitable target ACT for initiation of cardiopulmonary bypass [5]. A 2019 review of international centres showed variation in accepted ACTs [7], with the majority of clinicians targeting an ACT of either 400 s or 480 s to initiate cardiopulmonary bypass [7]. One study suggested that coagulation was activated with an ACT < 300 s and that 480 s should be targeted in order to incorporate a margin of safety [8].…”

Section: Discussionmentioning

confidence: 99%

Massive atrial myxoma requiring emergency cardiopulmonary bypass in a patient with heparin resistance

Houston

Moran

Mayhew

2020

Anaesthesia Reports

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Heparin exhibits complex pharmacology with a wide variation in individual response. Despite this, heparin is the most commonly used anticoagulant during cardiopulmonary bypass. Heparin resistance in the context of a patient with severe cardiovascular compromise presents a potentially life-threatening challenge. A 31-year-old woman was listed for emergency excision of a massive left atrial myxoma. On induction of anaesthesia, she developed marked cardiovascular instability secondary to mitral inflow obstruction. An initial heparin dose of 600 units.kg-1 produced an activated clotting time of 360 s; however, immediate cardiopulmonary bypass was required. Heparin resistance remained problematic throughout the procedure, with an inadequate response to antithrombin three supplementation. Despite a total dose of 120,000 units of heparin, anticoagulation was fully reversed with 500 mg protamine and there was no subsequent re-heparinisation. Heparin resistance, when coinciding with profound cardiovascular instability, requires a pragmatic response to expedite establishment of cardiopulmonary bypass whilst minimising potential harm. In this case, successful cardiopulmonary bypass was achieved with additional heparin boluses from an alternative batch administered both intravenously and via the bypass circuit. We therefore advocate consideration of this approach as one possible solution to achieving safe entry onto cardiopulmonary bypass in a crisis scenario.

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Anticoagulation Management and Heparin Resistance During Cardiopulmonary Bypass: A Survey of Society of Cardiovascular Anesthesiologists Members

Cited by 30 publications

References 6 publications

Correlation between activated clotting time monitoring and heparin concentration measurement in a patient with antiphospholipid syndrome during cardiac valve surgery: a case report

Correlation between activated clotting time monitoring and heparin concentration measurement in a patient with antiphospholipid syndrome during cardiac valve surgery: a case report

Management of heparin resistance due to antithrombin deficiency in a Chinese pregnant woman: a case report

Massive atrial myxoma requiring emergency cardiopulmonary bypass in a patient with heparin resistance

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