PMID- 19533051
OWN - NLM
STAT- MEDLINE
DCOM- 20091005
LR  - 20211020
IS  - 1615-6722 (Electronic)
IS  - 0723-5003 (Linking)
VI  - 104
IP  - 6
DP  - 2009 Jun 15
TI  - [Heparin resistance and antithrombin deficiency].
PG  - 441-9
LID - 10.1007/s00063-009-1093-8 [doi]
AB  - The phenomenon of heparin resistance (HR) is characterized by high doses of 
      unfractionated heparin (UFH) being required to bring activated partial 
      thromboplastin time (aPTT) and activated coagulation time (ACT) within 
      therapeutically desired ranges, or by the impossibility of reaching these ranges. 
      At UFH dosages > 35,000 IU/d, HR should be considered a factor. The most frequent 
      cause of HR is deficiency of antithrombin (AT), the presence of which is 
      essential for UFH to exert its anticoagulatory effect. AT in concentrate form may 
      be applied to overcome AT-dependent HR. The main clinically relevant situations 
      in which AT-dependent HR occurs, with possible indication of AT substitution, are 
      congenital AT deficiency, asparaginase therapy, disseminated intravascular 
      coagulation (DIC) and administration of high doses of heparin during 
      extracorporeal circulation, where it is significant, due to the need to maintain 
      a very high ACT (> 400 s), that use of heart-lung machines is associated with an 
      HR incidence of approximately 20%. The following procedure is recommended when 
      there is no DIC and when extracorporeal circulation is not used: if HR is 
      suspected and AT activity is < or = 60%, UFH should first be reduced to 500 IU/h 
      (to prevent bleeding complications), before AT is substituted. AT activity should 
      then exceed 80%. Under normalized and stable AT activity, the UFH dose should be 
      adjusted such that aPTT is within a range of 60-100 s. If anticoagulation over a 
      longer term is indicated, then overlapping anticoagulation with a vitamin K 
      antagonist should be started as quickly as possible.
FAU - Maurin, Norbert
AU  - Maurin N
AD  - KfH-Nierenzentrum Neuwied, Neuwied, Germany. norbert.maurin@kfh-dialyse.de
LA  - ger
PT  - English Abstract
PT  - Journal Article
PT  - Review
TT  - Heparinresistenz und Antithrombinmangel.
DEP - 20090616
PL  - Germany
TA  - Med Klin (Munich)
JT  - Medizinische Klinik (Munich, Germany : 1983)
JID - 8303501
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9000-94-6 (Antithrombin III)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Antithrombin III/administration & dosage
MH  - Antithrombin III Deficiency/blood/*drug therapy/etiology/genetics
MH  - Drug Resistance
MH  - Extracorporeal Circulation
MH  - Extracorporeal Membrane Oxygenation
MH  - Heparin/*administration & dosage/adverse effects
MH  - Heparin, Low-Molecular-Weight/administration & dosage
MH  - Humans
MH  - *Partial Thromboplastin Time
MH  - Platelet Count
MH  - Renal Dialysis
MH  - Risk Factors
MH  - Venous Thrombosis/blood/prevention & control
MH  - *Whole Blood Coagulation Time
RF  - 87
EDAT- 2009/06/18 09:00
MHDA- 2009/10/06 06:00
CRDT- 2009/06/18 09:00
PHST- 2009/02/26 00:00 [received]
PHST- 2009/04/27 00:00 [accepted]
PHST- 2009/06/18 09:00 [entrez]
PHST- 2009/06/18 09:00 [pubmed]
PHST- 2009/10/06 06:00 [medline]
AID - 10.1007/s00063-009-1093-8 [doi]
PST - ppublish
SO  - Med Klin (Munich). 2009 Jun 15;104(6):441-9. doi: 10.1007/s00063-009-1093-8. Epub 
      2009 Jun 16.