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Predictors for heparin resistance in patients undergoing coronary artery bypass grafting

Department of Cardiovascular Anaesthesia, University of Milan, San Donato Hospital, m.ranucci{at}galactica.it

Giuseppe Isgrò

Department of Cardiovascular Anaesthesia, University of Milan, San Donato Hospital

Anna Cazzaniga

Department of Cardiovascular Anaesthesia, University of Milan, San Donato Hospital

Giorgio Soro

Department of Cardiovascular Anaesthesia, University of Milan, San Donato Hospital

Lorenzo Menicanti

Department of Cardiac Surgery, Cardiovascular Centre E. Malan, University of Milan, San Donato Hospital

Alessandro Frigiola

Department of Cardiac Surgery, Cardiovascular Centre E. Malan, University of Milan, San Donato Hospital

Heparin resistance (HR) is a common event in cardiac operations. At present, no clear recognition of the risk factors for HR has been reached. The aim of this study was to determine a predictive model for HR, based on the preoperative patient’s profile. Two hundred consecutive patients scheduled for elective coronary artery bypass operations were enrolled in a prospective trial. Demographics, type of preoperative anticoagulation therapy and preoperative coagulation profile were collected and statistically analysed with respect to the evidence of a HR. Heparin resistance was defined as at least one activated clotting time < 400 s after heparinization and/or the need for purified antithrombin III (AT-III) administration. With a multivariate analysis we could identify five predictors for HR: AT-III 60%; preoperative subcutaneous heparin therapy; intravenous heparin therapy; platelet count 300 000 cells/mm³; age 65 years. We conclude that HR is a predictable event. In the presence of all the risk factors, the likelihood of HR is 99%; in the absence of all of them, it is 10%. Predicting HR allows us to apply many possible therapeutic strategies.

Perfusion, Vol. 14, No. 6, 437-442 (1999)
DOI: 10.1177/026765919901400606


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