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Heparin..Part III..Resistance Treatment





While heparin resistance is real, the question as to how to deal with this is somewhat less straightforward.  Levine et al. looked at 131 patients with so called heparin resistance and found that although the aPTT seemed to indicate resistance to heparin, following anti-Xa heparin activity resulted in far less heparin requirements . The conclusion from this study was that the heparin assay should be used in patients where suspicion for heparin resistance exists. Unfortunately, this has little benefit in the acute surgical setting where resistance is detected for the first time intraoperatively therapeutic anti coagulation is required urgently.

If you are dealing with a situation in which you suspect AT levels to be below normal, then FFP is a therapeutic option as it contains AT.  While FFP is available in almost all blood banks and relatively inexpensive , it does carry the risk of transmission of viral infections.  Furthermore, FFP requires time to thaw which may not be a good option in the acute surgical setting where the patient is actively clotting.


 In the US, AT concentrate is available which although more expensive (around $840), doesn't require thawing and has no risk of viral transmission.  When treating with AT concentrate the goal of therapy is to raise AT activity to 120% of normal baseline levels.  This can often be achieved with 1 vial of 500 IU of thrombate (AT concentrate) reconstituted in 10 mL of sterile water which is approximate to 2 units of FFP.


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