How is heparin resistance treated?

Heparin resistance occurs in up to 22% of patients undergoing cardiac surgery requiring cardiopulmonary bypass and it is associated with decreased levels of antithrombin. Treatment options for heparin resistance include administration of antithrombin or fresh frozen plasma.

Do you monitor PT or PTT with heparin?

Heparin is an anticoagulation drug that is given intravenously (IV) or by injection to prevent and to treat blood clots (embolism and thromboembolism). It prolongs PTT. When heparin is administered for therapeutic purposes, it must be closely monitored.

Can you be resistant to heparin?

Heparin resistance is defined as the need for more than 35 000 units in a 24-hour period to prolong activated PTT in the therapeutic range. Heparin resistance occurs in up to 22% of patients undergoing cardiopulmonary bypass, and 65% of these cases are secondary to ATIII deficiency.

Do you monitor PT with heparin?

Daily monitoring of PT/INR and aPTT is recommended for patients concurrently on heparin and warfarin.

What is the definition of heparin Resistance ( HR )?

Abstract The phenomenon of heparin resistance (HR) is characterized by high doses of unfractionated heparin (UFH) being required to bring activated partial thromboplastin time (aPTT) and activated coagulation time (ACT) within therapeutically desired ranges, or by the impossibility of reaching these ranges.

How much Heparin is needed to achieve therapeutic anticoagulation?

Heparin resistance is generally defined as either requiring >35,000 IU/day heparin to achieve therapeutic anticoagulation or being unable to achieve therapeutic anticoagulation ( Durrani et al 2018 ). Consider evaluating for heparin resistance if the infusion is increasing above ~25 units/kg/hr.

When to stop heparin infusion for high risk patients?

For those with active clot or high risk for clotting, there must be a five day overlap of both drugs AND 2. Achieve single therapeutic INR ≥ 2 prior to stopping heparin infusion. 1. Wait 3 hours after discontinuation of heparin infusion to start ar gatroban infusion.

How are LMWH preparations different from heparin preparations?

LMWH preparations have differences in the distribution of heparin chain lengths. The ratio of anti-Xa activity to anti-IIa activity varies between preparations (between roughly ~2:1 to ~4:1). Fondaparinux is essentially a synthetic, short molecule shaped like heparin.