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Anticoagulation Management and Heparin Resistance During Cardiopulmonary Bypass

A Survey of Society of Cardiovascular Anesthesiologists Members

Sniecinski, Roman M., MD, MSc*; Bennett-Guerrero, Elliott, MD; Shore-Lesserson, Linda, MD

doi: 10.1213/ANE.0000000000003981
Cardiovascular and Thoracic Anesthesiology: PDF Only

We surveyed Society of Cardiovascular Anesthesiologists members regarding anticoagulation practices for cardiopulmonary bypass and attitudes on heparin resistance. Of 550 respondents (18.5% response rate), 74.9% (95% CI, 71.3%–78.5%) used empiric weight-based dosing of heparin, and 70.7% (95% CI, 66.9%–74.5%) targeted an activated clotting time of either 400 or 480 seconds to initiate cardiopulmonary bypass. Of note, 17.1% (95% CI, 13.9%–20.2%) of respondents reported activated clotting time targets lower than those recommended by recent 2018 Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists/American Society of Extracorporeal Technology guidelines or failed to monitor heparin effects at all. When heparin resistance was encountered, 54.2% of respondents (95% CI, 50.0%–58.4%) administered antithrombin concentrates as a first-line therapy.

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From the *Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia

Department of Anesthesiology, Stony Brook School of Medicine, Stony Brook, New York

Department of Anesthesiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.

Accepted for publication November 13, 2018.

Funding: This work was supported by Grifols, S.A., in the form of a research grant.

The sponsor had no involvement in either data analysis or manuscript preparation.

Conflicts of Interest: See Disclosures at the end of the article.

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Address correspondence to Roman M. Sniecinski, MD, MSc, Department of Anesthesiology, Emory University Hospital, 1364 Clifton Rd, NE, Atlanta, GA 30322. Address e-mail to

© 2019 International Anesthesia Research Society