• Yoshikazu Kimura, Shuji Okahara, Kanae Abo, Yusuke Koyama, Mitsuhito Kuriyama, Kazumi Ono, and Hidekuni Hidaka.
• Department of Anesthesiology and Oncological Pain Medicine, Fukuyama City Hospital, Hiroshima, Japan. Electronic address: yoshikimura_16@yahoo.co.jp.
• J. Cardiothorac. Vasc. Anesth. 2021 Dec 1; 35 (12): 3568-3573.

ObjectivesHeparin resistance (HR), defined as a decrease in heparin responsiveness, can result in adverse events with prolonged duration of surgery. Although some clinical risk factors have been suggested, the relationship with the surgical diagnosis is unclear. The aim of present study was to elucidate the clinical predictors of HR including the surgical diagnosis.DesignThis retrospective cohort study determined the incidence of HR (defined as activated clotting time [ACT] <400 seconds after 250-350 IU/kg of heparin administration) and heparin sensitivity index (HSI) was calculated from the rate of change in ACT per heparin dose. Preoperative demographic data, medication history, and laboratory data also were analyzed.SettingSingle institution, tertiary care hospital.ParticipantsAdult patients who underwent cardiovascular surgery with cardiopulmonary bypass between January 2012 and September 2018.InterventionsNone.Measurements And Main ResultsOf 287 patients, 88 (30.7%) were classified as HR. In univariate analysis, infective endocarditis (IE), platelet count, and serum fibrinogen and albumin levels were associated with HR. After adjustment for baseline ACT and initial heparin dose, IE (odds ratio 4.57, [95% CI: 1.10-19.1]; p = 0.037) and albumin ≤3.5 g/dL (3.17, [1.46-6.93]; p = 0.004) were associated independently with HR. Patients with IE had significantly lower HSI than those with other diseases. All HR patients were treated with additional heparin, and 17 of them received human antithrombin-III concentrate.ConclusionsInfective endocarditis and preoperative hypoalbuminemia were associated independently with HR. The optimal anticoagulation strategy for patients with these risk factors requires further investigations based on the authors' findings.Copyright © 2021 Elsevier Inc. All rights reserved.

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