Heparin Anticoagulation during Cardiopulmonary Bypass in an Antithrombin-III Deficient Patient: Implications Relative to the Etiology of Heparin Rebound

Abstract

A case of antithrombin-III (AT-III) deficiency was diagnosed on the basis of a diminished anticoagulant effect following the administration of heparin for cardiopulmonary bypass. The clinical evaluation and interpretation of a diminished response to heparin is discussed, as are considerations relative to the treatment of AT-III deficient persons whose disorder is not manifest until they are already anesthetized for cardiovascular bypass. The implications of AT-III deficiency relative to the mechanism of heparin rebound are also discussed.

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…Data supporting treatment of heparin resistance with fresh-frozen plasma are isolated to retrospective studies and case reports. [400][401][402][403][404] Studies supporting AT III supplementation for the treatment of heparin resistance include 4 randomized, controlled trials showing prolongation of ACT or a reduction in hemostatic activation. [405][406][407][408][409][410][411][412][413][414][415] AT III concentrate is a stable, lyophilized product derived from pooled normal human plasma, purified, and heat treated at 60°C for 10 hours to eliminate the possibility of viral transmission.…”

The evaluations of frequency distribution heparin resistance during coronary artery bypass graft

“…Its incidence was higher than the heparin resistant to patients, but with not significant differences (33.3% vs. 12.4%), and this is a normal finding in the patients because the incidence of heparin resistance on patients provide coagulation disorders and also if the preventative actions do not happen, bleeding is a common occurrence for such patients. [3] Other complications were the cardiopulmonary arrest, which occurred in 8% of our patients and the difference was no significant in heparin resistant patients and non-resistant to heparin. In our study, 33.3% patients who were in resistant to heparin group suffering from cardiopulmonary arrest, whereas the incidence of this complication was 7.2% in non heparin resistant patients.…”

“…Furthermore, disease and other problems such as thrombocytopenia and increased activity of factor 8, and previous history of endocarditic IABP and can also cause resistance to heparin. However, the main issue at this case is that the incidence of heparin resistance to multiple causes, which was mentioned, some of them had been increased[1234567] and this is important at CABG surgery. Complications associated with heparin resistance, such as arrhythmia, bleeding, arrest and death was items that we examined in our study.…”

“…The word bypass means by-way, since in the bypass surgery, surgeon removes the legs or chest arteries and use them as a bypass for blocked coronary artery, so the surgery has been named as bypass. [123] Transfusion of patient blood circulation to heart-lung pump or cardiopulmonary bypass circuit (CPB circuit) in coronary bypass surgery is an essential component of operation. To address this pump, blood is likely to increase coagulation.…”

Rebound Phenomena: Results of a 10 Years’ (1970-1980) Literature Review

“…The administration of blood products containing AT-III thus induces the so-called rebound. Another study reported heparin re bound and postoperative bleeding [87], Here the term 'heparin rebound' implies reappearance of heparin in blood following its neutralization at the end of the operation (cardiac surgery). The reappearance of a state of hypocoagulability of blood after initial adequate neutralization occurs because of the escape of heparin into the extravascular compartment and its return via the lymphatics and the thoracic duct several hours later.…”