Investigation of real-world heparin resistance and anticoagulation management prior to cardiopulmonary bypass: report from a nationwide survey by the Japanese Association for Thoracic Surgery heparin resistance working group.

Autor: Ito K; Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan., Sasaki K; Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan., Ono M; Department of Cardiac Surgery, The University of Tokyo, Tokyo, Japan., Suzuki T; Department of Pediatric Cardiac Surgery, Saitama Medical University International Medical Center, Saitama, Japan., Sakamoto K; Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan., Okamoto H; Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Japan., Katori N; Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan., Momose N; Department of Medical Center, Jichi Medical University, Saitama, Japan., Araki Y; Department of Clinical Engineering, Saiseikai Kumamoto Hospital, Kumamoto, Japan., Tojo K; Department of Medical Engineering, Kitasato University Hospital, Sagamihara, Japan., Ieko M; Department of Hematology, Iwate Prefectural Chubu Hospital, Kitakami, Japan., Komiyama Y; Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa, Japan., Saiki Y; Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan. yoshisaiki@med.tohoku.ac.jp.
Jazyk: angličtina
Zdroj: General thoracic and cardiovascular surgery [Gen Thorac Cardiovasc Surg] 2024 Jan; Vol. 72 (1), pp. 8-14. Date of Electronic Publication: 2023 May 17.
DOI: 10.1007/s11748-023-01936-5
Abstrakt: Objective: Heparin resistance is often encountered during cardiopulmonary bypass. Heparin dose and activated clotting time target values for the initiation of cardiopulmonary bypass are not yet universally standardized; further no consensus exists on the management of heparin resistance. This study aimed to investigate the current real-world practice on heparin management and anticoagulant treatment for heparin resistance in Japan.
Methods: A questionnaire survey was conducted at medical institutions nationwide with which The Japanese Society of Extra-Corporeal Technology in Medicine members are affiliated, targeting surgical cases with cardiopulmonary bypass performed from January 2019 through December 2019.
Results: Among 69% (230/332) of the participating institutions, the criterion for heparin resistance was defined as "the target activated clotting time value not reached even with an additional dose of heparin administration". Cases of heparin resistance were reported in 89.8% (202/225) of the responded institutions. Of note, 75% (106/141) of the responded institutions reported heparin resistance associated with antithrombin activity ≥ 80%. Antithrombin concentrate was used in 38.4% (238/619 responses) or third dose of heparin in 37.8% (234/619 responses) for advanced heparin resistance treatment. Antithrombin concentrate was found to be effective in resolving heparin resistance in patients having normal, as well as lower antithrombin activity.
Conclusion: Heparin resistance has occurred in many cardiovascular centers, even among patients with normal antithrombin activities. Interestingly, the administration of antithrombin concentrate resolved heparin resistance, regardless of the baseline antithrombin activity value.
(© 2023. The Author(s).)
Databáze: MEDLINE
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