title: Successful anticoagulation with fresh frozen plasma for cardiopulmonary bypass in a patient with heparin resistance: a cautionary tale.
abstract: Heparin resistance (HR) is an increasingly common occurrence due to a greater awareness of the benefits of antithrombosis prophylaxis in hospitalised patients with low molecular weight and unfractionated heparin. Furthermore as more high-risk patients with prior heparin exposure undergo cardiac surgery we can expect to encounter more such cases. Adequate anticoagulation is essential for the safe conduct of any operation requiring cardiopulmonary bypass and is usually achieved with systemic heparinisation. We report a case of successful anticoagulation with the intraoperative administration of fresh frozen plasma in a high-risk coronary patient with HR and highlight the perils of unwitting overheparinisation in such cases. This case highlights the importance of clinical awareness of this phenomenon and the available alternative anticoagulants.
authors: Department of Cardiothoracic Surgery, Serdang Hospital, Ministry of Health, Kuala Lumpur, Malaysia.
authors: Omar
authors: O
authors: Badrin
authors: Suana
authors: S
authors: Kushairi
authors: Zuhrah
authors: Z
authors: Zakaria
authors: Anand
authors: A
authors: Sachithanandan
mesh_terms: D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000601:surgery*; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D004452:Echocardiography; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma
chemical_list: D000925:Anticoagulants; D006493:Heparin
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