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SM Journal of Anesthesia

Heparin Resistance and Management in Congenital Heart Surgery: Case Report

[ ISSN : 3068-0891 ]

Abstract
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Received: 22-Jan-2017

Accepted: 10-Feb-2017

Published: 15-Feb-2017

Case Report | Volume 3 - Issue 1 | Article DOI :

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Dilek Altun¹*, Adnan Yüksek¹, Ahmet Arnaz², Yusuf Kenan Yalçınbaş³, and Tayyar Sarıoğlu⁴

¹Ac?badem Bak?rköy Hospital, Anaesthesiology and Reanimation (Cardiovascular), Bak?rköy/?stanbul, Turkey
²Ac?badem University, Ac?badem Bak?rköy Hospital, Cardiovascular Surgery, Bak?rköy/?stanbul, Turkey
³Ac?badem Bak?rköy Hospital, Cardiovascular Surgery, Bak?rköy/?stanbul, Turkey
?Ac?badem University Medical Faculty, Pediatric Cardiac Surgery, Bak?rköy/?stanbul, Turkey

Corresponding Author:

Dilek Altun, Ac?badem Hospital, Department of Anesthesiology, Zeytinlik, Halit Ziya U?akl?gil Street. No: 1, 34140 Bak?rköy/?stanbul, Tel: +905-324-932 767; Fax: +902-124-144-444; E-mail: drdilekaltun@hotmail.com

Keywords

Congenital heart surgery; Cardiopulmonary bypass; Heparin resistance; Activated coagulation time; Fresh frozen plasma

Abstract

Anticoagulation for cardiopulmonary bypass is maintained with heparin. The primary mechanism of action of this drug is the activation of antithrombin III, which prevents thrombin transformation from prothrombin. Thus, it reduces the formation of clot. However, in some cases, despite a standard heparin dose, the intended active coagulation time cannot be obtained which is known as heparin resistance. Heparin resistance occurs in up to 22% of patients undergoing cardiac surgery requiring cardiopulmonary bypass and it is associated with decreased levels of antithrombin. Heparin resistance, although seen rare, can occur in varying severity in clinic. Treatment options for heparin resistance include administration of antithrombin or fresh frozen plasma. In this case presentation, we have reported the strategy for a planned pulmonary artery reconstruction operation under cardiopulmonary pypass in a patient that we could not maintain the adequate ACT levels despite a cumulative dose of 12 mg/kg heparin and 20 ml/kg fresh frosen plasma transfusion.

Citation

Altun D, Yüksek A, Arnaz A, Yalç?nba? YK and Sar?o?lu T. Heparin Resistance and Management in Congenital Heart Surgery: Case Report. SM J Anesth. 2017; 3(1): 1006.