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Open Access 01-12-2023 | Heparin | Case Report

Heparin-resistance in AL amyloidosis: a case report

Authors: Elisabeth S. van Ede, Marlijn P. A. Hoeks, Jan Hofland, Vera D. Linssen, Toin H. van Kuppevelt, Elly M. Versteeg, Theo G. Hafmans, Arjan Diepstra, Benno Kusters, Sanne M. M. Vermorgen

Published in: BMC Anesthesiology | Issue 1/2023

Abstract

Background

Non-AT-III mediated heparin-resistance during CPB occurs by complex-forming with heparin-binding proteins. Currently, there are no specific recommendations for non-AT-III mediated heparin-resistance.

Case presentation

We present a fatal case of a 70-yr-old male-patient undergoing cardiac-surgery in which refractory heparin-resistance was observed. The massive AL amyloidosis found at autopsy is thought to be responsible and illustrates that awareness and knowledge of the etiology and perioperative strategies of non-AT-III mediated heparin-resistance is important.

Conclusion

For anticoagulation during cardiopulmonary bypass surgery in case of a non-AT-III medicated heparin resistance, we refer to the decision tree added to this manuscript and if necessary to consider direct thrombin inhibitors, such as bivalirudin or argatroban, as it bypasses the complexing pathway.

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Title: Heparin-resistance in AL amyloidosis: a case report
Authors: Elisabeth S. van Ede
Marlijn P. A. Hoeks
Jan Hofland
Vera D. Linssen
Toin H. van Kuppevelt
Elly M. Versteeg
Theo G. Hafmans
Arjan Diepstra
Benno Kusters
Sanne M. M. Vermorgen
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Heparin
AL Amyloidosis
Published in: BMC Anesthesiology / Issue 1/2023
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-023-02147-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Heparin-resistance in AL amyloidosis: a case report

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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