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Korean Journal of Anesthesiology 2005;49(6):868-871.
DOI: https://doi.org/10.4097/kjae.2005.49.6.868   
Heparin Resistance during Cardiopulmonary Bypass in Infective Endocarditis Patients: A case report.
Sungwon Na, Sang Boem Nam, Young Joon Oh, Jong Hwa Lee, So Woon Ahn, Young Lan Kwak
1Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. ylkwak@yumc.yonsei.ac.kr
2Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Appropriate anticoagulation is essential for safe cardiopulmonary bypass (CPB). Two patients with infective endocarditis were scheduled for valve replacement. After an intravenous heparin injection for the CPB, the increases in the activated clotting time (ACT) in both patients were less than expected. Subsequent additional heparin administration failed to maintain a sufficient ACT for the CPB, and antithrombin III (AT III) tests during the CPB revealed low activities in both patients. Heparin resistance, due to consumption of circulating AT III as a result of infective endocarditis or prior heparinization, was postulated. While fresh frozen plasma (FFP) could not be timely administered in the first patient, ACT was successfully prolonged after the administration of FFP in the second. It is strongly suggested that adequate management of heparin resistance should be prepared for patients with infective endocarditis who require CPB.
Key Words: antithrombin III deficiency; heparin resistance; infective endocarditis
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