Heparin Resistance in Cardiac Surgery with Cardiopulmonary Bypass: Mechanisms, Clinical Implications, and Evidence-Based Management.
Review published in Medicina (Kaunas, Lithuania) (2025)
Abstract
Background: Unfractionated heparin (UFH) is the standard anticoagulant during cardiopulmonary bypass (CPB). A clinically relevant subset develops heparin resistance (HR)-failure to reach adequate anticoagulation with usual UFH-raising thrombotic risk and complicating perioperative care. Objectives: To synthesize contemporary evidence on the mechanisms, clinical implications, and perioperative management of HR in adult cardiac surgery with CPB. Methods: This narrative review synthesizes contemporary evidence on the epidemiology, mechanisms, recognition, and management of HR in adult cardiac surgery with CPB, emphasizing clinically actionable points. Results: Incidence varies across centers and definitions. Mechanisms include antithrombin (AT) deficiency or consumption and AT-independent drivers such as systemic inflammation or sepsis, protein-loss states, thrombocytosis, hyperfibrinogenemia, obesity, prior heparin exposure, and drug interactions. Sole reliance on activated clotting time (ACT) may misestimate anticoagulant effect; anti-factor Xa (anti-Xa) assays or heparin titration systems improve assessment when available. Management is stepwise: UFH dose escalation; targeted AT supplementation (or fresh frozen plasma where concentrates are unavailable); and transition to direct thrombin inhibitors when HR persists or UFH is contraindicated. Protocolized pathways and multidisciplinary coordination reduce delays and adverse events. Conclusions: HR is a multifactorial, common challenge in CPB. Pre-bypass risk assessment, multimodal monitoring, and an algorithm prioritizing UFH optimization, AT repletion, and timely use of direct thrombin inhibitors provide a pragmatic framework to limit thrombosis and bleeding. Harmonized definitions and comparative trials remain priorities.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
: Unfractionated heparin (UFH) is the standard anticoagulant during cardiopulmonary bypass (CPB). A clinically relevant subset develops heparin resistance (HR)-failure to reach adequate anticoagulation with usual UFH-raising thrombotic risk and complicating perioperative care.: To synthesize...
Por qué esto importa para la hirudoterapia
Esta revisión narrativa sintetiza la evidencia sobre la resistencia a la heparina durante cirugía cardíaca adulta con circulación extracorpórea, analizando mecanismos como la deficiencia/consumo de antitrombina y los impulsores independientes de antitrombina, la monitorización con tiempo de coagulación activado y ensayos anti-factor Xa, y el manejo escalonado mediante escalada de heparina no fraccionada, suplementación con antitrombina e inhibidores directos de la trombina cuando la resistencia a la heparina persiste o la HNF está contraindicada. El resumen es relevante para el manejo perioperatorio de la anticoagulación y la atención de la coagulación. Solo identifica la clase farmacológica de los inhibidores directos de la trombina y no menciona la hirudina, los agentes derivados de la sanguijuela ni la hirudoterapia. En consecuencia, el artículo no aporta evidencia directa sobre la terapia con sanguijuelas ni sobre el secretoma de la sanguijuela, y no puede inferirse ninguna relevancia específica para la sanguijuela.
Citación
Heparin Resistance in Cardiac Surgery with Cardiopulmonary Bypass: Mechanisms, Clinical Implications, and Evidence-Based Management.
Rivera Jiménez et al. · Medicina (Kaunas, Lithuania), 2025
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: 18 de junio de 2026