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General Thoracic and Cardiovascular Surgery

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Open Access 17-05-2023 | Anticoagulant | Original Article

Investigation of real-world heparin resistance and anticoagulation management prior to cardiopulmonary bypass: report from a nationwide survey by the Japanese Association for Thoracic Surgery heparin resistance working group

Authors: Koki Ito, Konosuke Sasaki, Minoru Ono, Takaaki Suzuki, Kisaburo Sakamoto, Hirotsugu Okamoto, Nobuyuki Katori, Naoki Momose, Yasuyuki Araki, Keiichi Tojo, Masahiro Ieko, Yutaka Komiyama, Yoshikatsu Saiki

Published in: General Thoracic and Cardiovascular Surgery | Issue 1/2024

Abstract

Objective

Heparin resistance is often encountered during cardiopulmonary bypass. Heparin dose and activated clotting time target values for the initiation of cardiopulmonary bypass are not yet universally standardized; further no consensus exists on the management of heparin resistance. This study aimed to investigate the current real-world practice on heparin management and anticoagulant treatment for heparin resistance in Japan.

Methods

A questionnaire survey was conducted at medical institutions nationwide with which The Japanese Society of Extra-Corporeal Technology in Medicine members are affiliated, targeting surgical cases with cardiopulmonary bypass performed from January 2019 through December 2019.

Results

Among 69% (230/332) of the participating institutions, the criterion for heparin resistance was defined as “the target activated clotting time value not reached even with an additional dose of heparin administration”. Cases of heparin resistance were reported in 89.8% (202/225) of the responded institutions. Of note, 75% (106/141) of the responded institutions reported heparin resistance associated with antithrombin activity ≥ 80%. Antithrombin concentrate was used in 38.4% (238/619 responses) or third dose of heparin in 37.8% (234/619 responses) for advanced heparin resistance treatment. Antithrombin concentrate was found to be effective in resolving heparin resistance in patients having normal, as well as lower antithrombin activity.

Conclusion

Heparin resistance has occurred in many cardiovascular centers, even among patients with normal antithrombin activities. Interestingly, the administration of antithrombin concentrate resolved heparin resistance, regardless of the baseline antithrombin activity value.

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Title: Investigation of real-world heparin resistance and anticoagulation management prior to cardiopulmonary bypass: report from a nationwide survey by the Japanese Association for Thoracic Surgery heparin resistance working group
Authors: Koki Ito
Konosuke Sasaki
Minoru Ono
Takaaki Suzuki
Kisaburo Sakamoto
Hirotsugu Okamoto
Nobuyuki Katori
Naoki Momose
Yasuyuki Araki
Keiichi Tojo
Masahiro Ieko
Yutaka Komiyama
Yoshikatsu Saiki
Publication date: 17-05-2023
Publisher: Springer Nature Singapore
Keywords: Anticoagulant
Heparin
Published in: General Thoracic and Cardiovascular Surgery / Issue 1/2024
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-023-01936-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Investigation of real-world heparin resistance and anticoagulation management prior to cardiopulmonary bypass: report from a nationwide survey by the Japanese Association for Thoracic Surgery heparin resistance working group

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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