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Defining heparin resistance: communication from the ISTH SSC Subcommittee of Perioperative and Critical Care Thrombosis and Hemostasis.

Publication ,  Journal Article
Levy, JH; Sniecinski, RM; Rocca, B; Ghadimi, K; Douketis, J; Frere, C; Helms, J; Iba, T; Koster, A; Lech, TK; Maier, CL; Neal, MD; Tafur, AJ ...
Published in: J Thromb Haemost
December 2023

The term heparin resistance (HR) is used by clinicians without specific criteria. We performed a literature search and surveyed our SSC membership to better define the term when applied to medical and intensive care unit patients. The most common heparin dosing strategy reported in the literature (53%) and by survey respondents (80.4%) was the use of weight-based dosing. Heparin monitoring results were similar based on the proportion of publications and respondents that reported the use of anti-Xa and activated partial thromboplastin time. The most common literature definition of HR was >35 000 U/d, but no consensus was reported among survey respondents regarding weight-based and the total dose of heparin when determining resistance. Respondent consensus on treating HR included antithrombin supplementation, direct thrombin inhibitors, or administering more heparin as the strategies available for treating HR. A range of definitions for HR exist. Given the common use of heparin weight-based dosing, future publications employing the term HR should include weight-based definitions, monitoring assay, and target level used. Further work is needed to develop a consensus for defining HR.

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Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

December 2023

Volume

21

Issue

12

Start / End Page

3649 / 3657

Location

England

Related Subject Headings

  • Thrombosis
  • Partial Thromboplastin Time
  • Humans
  • Heparin
  • Hemostasis
  • Critical Care
  • Communication
  • Cardiovascular System & Hematology
  • Antithrombins
  • Anticoagulants
 

Citation

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Levy, J. H., Sniecinski, R. M., Rocca, B., Ghadimi, K., Douketis, J., Frere, C., … Connors, J. M. (2023). Defining heparin resistance: communication from the ISTH SSC Subcommittee of Perioperative and Critical Care Thrombosis and Hemostasis. J Thromb Haemost, 21(12), 3649–3657. https://doi.org/10.1016/j.jtha.2023.08.013
Levy, Jerrold H., Roman M. Sniecinski, Bianca Rocca, Kamrouz Ghadimi, James Douketis, Corinne Frere, Julie Helms, et al. “Defining heparin resistance: communication from the ISTH SSC Subcommittee of Perioperative and Critical Care Thrombosis and Hemostasis.J Thromb Haemost 21, no. 12 (December 2023): 3649–57. https://doi.org/10.1016/j.jtha.2023.08.013.
Levy JH, Sniecinski RM, Rocca B, Ghadimi K, Douketis J, Frere C, et al. Defining heparin resistance: communication from the ISTH SSC Subcommittee of Perioperative and Critical Care Thrombosis and Hemostasis. J Thromb Haemost. 2023 Dec;21(12):3649–57.
Levy, Jerrold H., et al. “Defining heparin resistance: communication from the ISTH SSC Subcommittee of Perioperative and Critical Care Thrombosis and Hemostasis.J Thromb Haemost, vol. 21, no. 12, Dec. 2023, pp. 3649–57. Pubmed, doi:10.1016/j.jtha.2023.08.013.
Levy JH, Sniecinski RM, Rocca B, Ghadimi K, Douketis J, Frere C, Helms J, Iba T, Koster A, Lech TK, Maier CL, Neal MD, Scarlestscu E, Spyropoulos A, Steiner ME, Tafur AJ, Tanaka KA, Connors JM. Defining heparin resistance: communication from the ISTH SSC Subcommittee of Perioperative and Critical Care Thrombosis and Hemostasis. J Thromb Haemost. 2023 Dec;21(12):3649–3657.
Journal cover image

Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

December 2023

Volume

21

Issue

12

Start / End Page

3649 / 3657

Location

England

Related Subject Headings

  • Thrombosis
  • Partial Thromboplastin Time
  • Humans
  • Heparin
  • Hemostasis
  • Critical Care
  • Communication
  • Cardiovascular System & Hematology
  • Antithrombins
  • Anticoagulants