A case report of heparin resistance due to acquired antithrombin III deficiency.
A case of heparin resistance and its management during cardiopulmonary bypass is reported. A patient with a history of post-infarct angina and arrhythmias was treated with intravenous heparin infusion for five days prior to myocardial revascularisation surgery. He required 13,500 IU/kg of heparin to increase his activated clotting time to a therapeutic level for safe institution of cardiopulmonary bypass. This phenomenon of heparin resistance was postulated to be due to consumption of circulating antithrombin III as a result of prior heparinisation. Treatment with fresh frozen plasma restored heparin effectiveness.
Leong
C K
CK
Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore.
Ong
B C
BC
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D020152:Antithrombin III Deficiency / Q000139:chemically induced*; D001777:Blood Coagulation / Q000187:drug effects*; D002315:Cardiopulmonary Bypass; D004351:Drug Resistance; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D014914:Whole Blood Coagulation Time
D000925:Anticoagulants; D006493:Heparin