Incidence of Heparin Resistance during Cardio-Pulmonary Bypass in Adult Cardiac Surgery in the Era of COVID-19

Document Type : Review Article

Authors

1 Lecturer of cts ain Shams University

2 Professor of Cardiothoracic Surgery Ain Shams University

3 Professor cts ain Shams University

4 Professor of cts ain Shams University

5 Cts resident - medicine - MUST university - cairo

Abstract

Introduction: Amazing breakthroughs in cardiac surgery have been made possible by the use of cardiopulmonary bypass (CPB), which has made the operating field motionless and bloodless. It wasn't until the introduction of heparin and its powerful antidote, protamine, that it was possible to safely establish anticoagulation in the within the extracorporeal circuit (ECC) and then reverse it after surgery. However, some people may develop heparin resistance during CPB, resulting in subtherapeutic ACT levels because they are less sensitive to heparin. The thromboembolic phenomenon, severe postoperative bleeding, and consumptive coagulopathy are only a few risks that might arise from insufficient anticoagulation.
Objective: To calculate the prevalence of heparin resistance in adult cardiac surgery undergoing cardio-pulmonary bypass in the COVID-19 period.
Patients and Methods: For that we enrolled 229 selected from the patients would undergo Cardiac surgery using cardio-pulmonary bypass, all cases confirmed to have covid-19.
Results: In the current study, we estimated heparin resistance after preoperative heparin therapy. ACT-based definition of heparin resistance was used in our study (ACT less than 400 seconds after 300 U/kg heparin), we found the mean baseline ACT was 112.7 ± 9.2, the mean heparin loading was 5.9 ± 0.8 amp and, the mean post-loading ACT of all studied patients was 536.6 ± 108.1 and of all studied 229 patients, there were 21 patients (9.2%) with heparin resistance. In the present study, the extra heparin was used among 21 cases the mean extra heparin used was 2.9 ± 0.3 amp with minimum extra heparin of 2 amp and maximum extra heparin of 3 amp. And the mean post-extra ACT was 406.8 ± 116.02 with minimum post-extra ACT of 280 and maximum post-extra ACT of 615. Furthermore, there were 15 patients (71.4%) of heparin resistance needed FFP. The mean needed FFP was 1.93 ± 0.25 units, and the mean post-FFP ACT was 638.2 ± 95.5 with minimum post-FFP ACT of 521 and maximum post-FFP ACT of 845.
Conclusion: According to the findings, 9.2% of adult cardiac surgery patients experience heparin resistance during cardio-pulmonary bypass in the COVID-19 era.

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