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Recombinant human antithrombin III restores heparin responsiveness and decreases activation of coagulation in heparin-resistant patients during cardiopulmonary bypass.

Publication ,  Journal Article
Avidan, MS; Levy, JH; van Aken, H; Feneck, RO; Latimer, RD; Ott, E; Martin, E; Birnbaum, DE; Bonfiglio, LJ; Kajdasz, DK; Despotis, GJ
Published in: J Thorac Cardiovasc Surg
July 2005

OBJECTIVES: We sought to evaluate the efficacy of recombinant human antithrombin III for restoration of heparin responsiveness in heparin-resistant patients scheduled for cardiac surgery. METHODS: This was a multicenter, randomized, double-blind, placebo-controlled study in heparin-resistant patients undergoing elective cardiac surgery. Patients were considered heparin resistant if the activated clotting time was less than 480 seconds after 400 U/kg heparin. Fifty-two heparin-resistant patients were randomized into 2 cohorts. One cohort received a single bolus (75 U/kg) of recombinant human antithrombin III (n = 28), and the other, the placebo group (n = 24), received a normal saline bolus. If the activated clotting time remained less than 480 seconds, this was defined as treatment failure, and 2 units of fresh frozen plasma were transfused. Patients were monitored for adverse events during hospitalization. RESULTS: Six (21%) of the patients in the recombinant human antithrombin III group received fresh frozen plasma transfusions compared with 22 (92%) of the placebo-treated patients ( P < .001). Two units of fresh frozen plasma did not restore heparin responsiveness. There was no increased incidence of adverse events associated with recombinant human antithrombin III administration. Postoperative 24-hour chest tube bleeding was not different in the 2 groups. Surrogate measures of hemostatic activation suggested that there was less activation of the hemostatic system during cardiopulmonary bypass in the recombinant human antithrombin III group. CONCLUSION: Treatment with recombinant human antithrombin III in a dose of 75 U/kg is effective in restoring heparin responsiveness and promoting therapeutic anticoagulation for cardiopulmonary bypass in the majority of heparin-resistant patients. Two units of fresh frozen plasma were insufficient to restore heparin responsiveness. There was no apparent increase in bleeding associated with recombinant human antithrombin III.

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Published In

J Thorac Cardiovasc Surg

DOI

ISSN

0022-5223

Publication Date

July 2005

Volume

130

Issue

1

Start / End Page

107 / 113

Location

United States

Related Subject Headings

  • Whole Blood Coagulation Time
  • Respiratory System
  • Recombinant Proteins
  • Peptide Hydrolases
  • Middle Aged
  • Humans
  • Heparin
  • Hemostasis, Surgical
  • Fibrinolytic Agents
  • Drug Resistance
 

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Avidan, M. S., Levy, J. H., van Aken, H., Feneck, R. O., Latimer, R. D., Ott, E., … Despotis, G. J. (2005). Recombinant human antithrombin III restores heparin responsiveness and decreases activation of coagulation in heparin-resistant patients during cardiopulmonary bypass. J Thorac Cardiovasc Surg, 130(1), 107–113. https://doi.org/10.1016/j.jtcvs.2004.10.045
Avidan, M. S., J. H. Levy, H. van Aken, R. O. Feneck, R. D. Latimer, E. Ott, E. Martin, et al. “Recombinant human antithrombin III restores heparin responsiveness and decreases activation of coagulation in heparin-resistant patients during cardiopulmonary bypass.J Thorac Cardiovasc Surg 130, no. 1 (July 2005): 107–13. https://doi.org/10.1016/j.jtcvs.2004.10.045.
Avidan MS, Levy JH, van Aken H, Feneck RO, Latimer RD, Ott E, et al. Recombinant human antithrombin III restores heparin responsiveness and decreases activation of coagulation in heparin-resistant patients during cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2005 Jul;130(1):107–13.
Avidan, M. S., et al. “Recombinant human antithrombin III restores heparin responsiveness and decreases activation of coagulation in heparin-resistant patients during cardiopulmonary bypass.J Thorac Cardiovasc Surg, vol. 130, no. 1, July 2005, pp. 107–13. Pubmed, doi:10.1016/j.jtcvs.2004.10.045.
Avidan MS, Levy JH, van Aken H, Feneck RO, Latimer RD, Ott E, Martin E, Birnbaum DE, Bonfiglio LJ, Kajdasz DK, Despotis GJ. Recombinant human antithrombin III restores heparin responsiveness and decreases activation of coagulation in heparin-resistant patients during cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2005 Jul;130(1):107–113.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

ISSN

0022-5223

Publication Date

July 2005

Volume

130

Issue

1

Start / End Page

107 / 113

Location

United States

Related Subject Headings

  • Whole Blood Coagulation Time
  • Respiratory System
  • Recombinant Proteins
  • Peptide Hydrolases
  • Middle Aged
  • Humans
  • Heparin
  • Hemostasis, Surgical
  • Fibrinolytic Agents
  • Drug Resistance