Review article: heparin sensitivity and resistance: management during cardiopulmonary bypass.
Review published in Anesthesia and analgesia (2013)
Abstract
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 resistance are both complex and multifactorial. Furthermore, the ACT is not specific to heparin's anticoagulant effect and is affected by multiple variables that are commonly present during cardiac surgery. Due to these many variables, it remains unclear whether decreased heparin responsiveness as measured by the ACT represents inadequate anticoagulation. Nevertheless, many clinicians choose a target ACT to assess anticoagulation, and interventions aimed at achieving the target ACT are routinely performed in the setting of heparin resistance. Treatments for heparin resistance/alterations in heparin responsiveness include additional heparin or antithrombin supplementation. In this review, we discuss the variability of heparin potency, heparin responsiveness as measured by the ACT, and the current management of heparin resistance.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
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...
Por qué esto importa para la hirudoterapia
Esta revisión aborda la resistencia a la heparina durante la cirugía cardíaca —definida como la incapacidad de una dosis adecuada de heparina para elevar el tiempo de coagulación activado al nivel deseado— y examina su etiología multifactorial, las limitaciones del TCA como herramienta de monitorización y los enfoques de manejo que incluyen heparina adicional o suplementación de antitrombina. El artículo es solo indirectamente relevante para el dominio de ASH en la medida en que concierne a la farmacología de la anticoagulación, pero no menciona sanguijuelas, hirudoterapia, hirudina ni ningún compuesto derivado de sanguijuela. No se puede establecer un vínculo defendible específico sobre sanguijuelas a partir únicamente de este resumen; la relevancia se limita al contexto clínico general del manejo de anticoagulantes durante la derivación cardiopulmonar.
Citación
Review article: heparin sensitivity and resistance: management during cardiopulmonary bypass.
Finley et al. · Anesthesia and analgesia, 2013
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: 18 de junio de 2026