Journal of cardiothoracic and vascular anesthesia · 2025
Analysis of Risk Factors for Heparin Resistance During Cardiac Surgery: Does Antithrombin Deficiency Cause Heparin Resistance?
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Kim Youngin, Kim Sang Yoon, Chang Hyoung Woo, Jung Joon Chul, Lee Jae Hang, Park Sanghon, Kim Jun Sung
Аннотация
OBJECTIVES: To determine whether heparin resistance (HR) occurring during cardiopulmonary bypass (CPB) is associated with antithrombin (antithrombin III) activity.
DESIGN: Retrospective review of data collected prospectively in a single center.
SETTING: A tertiary referral hospital.
PARTICIPANTS: A total of 605 patients who underwent cardiovascular surgery with CPB, excluding emergency aortic dissection cases.
INTERVENTIONS: Cardiac valve and aortic surgeries were performed.
MEASUREMENTS AND MAIN RESULTS: HR was defined as an activated clotting time of less than 450 seconds measured after initial heparin administration (3 mg/kg) prior to CPB. Among the 605 patients, 164 were categorized into the HR group. Multivariable analysis revealed that patients with an active infection who underwent surgery had a significantly higher risk of developing HR (odds ratio [OR]: 2.30, 95% confidence interval [CI]: 1.25-4.21, p = 0.007). Compared with isolated valve surgery, isolated aortic surgery was associated with a higher risk of HR (OR: 1.74, 95% CI: 1.12-2.71, p = 0.014). Preoperative antithrombin activity did not show a significant association with HR (OR: 1.00, 95% CI: 0.98-1.01, p = 0.786). The incidence of major composite complications was significantly higher in the heparin-resistant group (33/164, 20.1%) compared with the non-heparin-resistant group (55/441, 12.5%, p = 0.025). However, no clear differences were observed in the incidence of individual complications.
CONCLUSIONS: An active infection and aortic surgery were identified as risk factors for HR. Antithrombin deficiency was not a significant risk factor for HR in cardiovascular surgery; thus, preoperative antithrombin supplementation for the prevention of HR may not be necessary.
DESIGN: Retrospective review of data collected prospectively in a single center.
SETTING: A tertiary referral hospital.
PARTICIPANTS: A total of 605 patients who underwent cardiovascular surgery with CPB, excluding emergency aortic dissection cases.
INTERVENTIONS: Cardiac valve and aortic surgeries were performed.
MEASUREMENTS AND MAIN RESULTS: HR was defined as an activated clotting time of less than 450 seconds measured after initial heparin administration (3 mg/kg) prior to CPB. Among the 605 patients, 164 were categorized into the HR group. Multivariable analysis revealed that patients with an active infection who underwent surgery had a significantly higher risk of developing HR (odds ratio [OR]: 2.30, 95% confidence interval [CI]: 1.25-4.21, p = 0.007). Compared with isolated valve surgery, isolated aortic surgery was associated with a higher risk of HR (OR: 1.74, 95% CI: 1.12-2.71, p = 0.014). Preoperative antithrombin activity did not show a significant association with HR (OR: 1.00, 95% CI: 0.98-1.01, p = 0.786). The incidence of major composite complications was significantly higher in the heparin-resistant group (33/164, 20.1%) compared with the non-heparin-resistant group (55/441, 12.5%, p = 0.025). However, no clear differences were observed in the incidence of individual complications.
CONCLUSIONS: An active infection and aortic surgery were identified as risk factors for HR. Antithrombin deficiency was not a significant risk factor for HR in cardiovascular surgery; thus, preoperative antithrombin supplementation for the prevention of HR may not be necessary.