Why do some patients exhibit resistance to heparin during cardiac surgery, even with normal antithrombin III (AT III) levels? This prospective trial identifies a subgroup of AT III-independent heparin-resistant patients, offering insights into managing heparin resistance during coronary revascularization. The findings have implications for improving patient outcomes during cardiac operations. The study enrolled 500 consecutive patients scheduled for coronary revascularization with cardiopulmonary bypass. Heparin resistance was identified in 20.8% of patients, with 7.2% exhibiting AT III activity ≥100%. Unlike other heparin-resistant patients, these subjects do not respond to AT III supplementation aimed at reaching supranormal AT III activity values. The identification of this subgroup enhances our understanding of heparin resistance and suggests alternative therapeutic strategies for patients undergoing cardiac operations. This research contributes to optimizing anticoagulation management in cardiac surgery.
Appearing in Perfusion, this paper aligns directly with the journal's focus on cardiovascular physiology and technology. The study addresses a critical issue in cardiac surgery—heparin resistance—and its implications for patient management during cardiopulmonary bypass. By identifying a distinct subgroup of heparin-resistant patients, this research enhances understanding of perfusion-related challenges and contributes to improving surgical outcomes.