ReviewThe journal of extra-corporeal technology2024
Heparin resistance management during cardiac surgery: a literature review and future directions.
Review in The journal of extra-corporeal technology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Real-world outcomes of unfractionated heparin plus antithrombin concentrate versus bivalirudin in adult patients undergoing extracorporeal membrane oxygenation.The journal of extra-corporeal technology · 2026Article
- A murine stable thrombosis model enabling therapeutic evaluation of antithrombotic drugs.Blood vessels, thrombosis & hemostasis · 2026Article
- Considerations to practice a safe and minimal administration of heparin and protamine during cardiopulmonary bypass.The journal of extra-corporeal technology · 2026Review
- Challenging Anticoagulation With Warfarin and Heparin Following Mechanical Mitral Valve Replacement in a Patient With Infective Endocarditis: A Case Report Highlighting Diagnostic Difficulties.Clinical case reports · 2026Article
- Dissecting the Chemical and Thermal Stabilities of Tetrads in G-Quadruplexes to Derive a Structure-Activity Relation for a Thrombin-Binding DNA G-Quadruplex Aptamer.Chembiochem : a European journal of chemical biology · 2026Article
- Direct Relationship Between Heparin Binding to Midkine and Pleiotrophin and the Development of Acute Deep Vein Thrombosis.Biomedicines · 2026Article
- Preparation and evaluation of a small-diameter vascular graft with dual anticoagulant and anticalcification functions.Regenerative biomaterials · 2026Article
- Heparin Resistance in Cardiac Surgery with Cardiopulmonary Bypass: Mechanisms, Clinical Implications, and Evidence-Based Management.Medicina (Kaunas, Lithuania) · 2025Review
- Leveraging machine learning for enhanced and interpretable risk prediction of venous thromboembolism in acute ischemic stroke care.PloS one · 2025Article
- Comprehensive Coagulation Management in Cardiac Surgery: Anticoagulants, Heparin Resistance, Monitoring, and Bleeding Risks : Coagulation Management in Cardiac Surgery.Galen medical journal · 2025Review
Corrections and comments
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Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionHeparin, 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.
conclusionOptimizing 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.
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