Previous Article in Journal
Improvement of Cardiometabolic Control with Dapagliflozin in Patients with Type 2 Diabetes in Primary Care: The AGORA-AP Study
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Medicina
Volume 61
Issue 12
10.3390/medicina61122088
medicina-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

Heparin Resistance in Cardiac Surgery with Cardiopulmonary Bypass: Mechanisms, Clinical Implications, and Evidence-Based Management

by
Karina E. Rivera Jiménez
1,
Yahaira M. Mamani Ticona
2,3,
Giancarlo Gutierrez-Chavez
4,
Cristian O. Astudillo
5,
Edisson Calle
6,
Giancarlo A. Torres Heredia
7,
Dario S. Lopez Delgado
8,
Oriana Rivera-Lozada
9 and
Joshuan J. Barboza
9,*
1
Instituto Nacional Cardiovascular, Lima 15072, Peru
2
Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional del Altiplano (SOCIEM UNA), Puno 21001, Peru
3
Facultad de Medicina Humana, Universidad Nacional del Altiplano, Puno 21001, Peru
4
Facultad de Ciencias de la Salud, Universidad Continental, Cusco 08000, Peru
5
Hospital San Sebastián, Cuenca 010111, Ecuador
6
Facultad de Ciencias Quimicas y de la Salud, Universidad Tecnica de Machala, Machala 070205, Ecuador
7
Facultad de Ciencias de la Salud, Universidad Privada Antenor Orrego, Trujillo 13008, Peru
8
Hospital Universitario Departamental de Nariño, Pasto 520001, Colombia
9
Vicerrectorado de Investigacion, Universidad Señor de Sipan, Chiclayo 14002, Peru
*
Author to whom correspondence should be addressed.
Medicina 2025, 61(12), 2088; https://doi.org/10.3390/medicina61122088 (registering DOI)
Submission received: 10 October 2025 / Revised: 13 November 2025 / Accepted: 21 November 2025 / Published: 23 November 2025
(This article belongs to the Special Issue Recent Advances in Cardiovascular Surgery)
Review Reports Versions Notes

Abstract

Background: Unfractionated heparin (UFH) is the standard anticoagulant during cardiopulmonary bypass (CPB). A clinically relevant subset develops heparin resistance (HR)—failure to reach adequate anticoagulation with usual UFH—raising thrombotic risk and complicating perioperative care. Objectives: To synthesize contemporary evidence on the mechanisms, clinical implications, and perioperative management of HR in adult cardiac surgery with CPB. Methods: This narrative review synthesizes contemporary evidence on the epidemiology, mechanisms, recognition, and management of HR in adult cardiac surgery with CPB, emphasizing clinically actionable points. Results: Incidence varies across centers and definitions. Mechanisms include antithrombin (AT) deficiency or consumption and AT-independent drivers such as systemic inflammation or sepsis, protein-loss states, thrombocytosis, hyperfibrinogenemia, obesity, prior heparin exposure, and drug interactions. Sole reliance on activated clotting time (ACT) may misestimate anticoagulant effect; anti–factor Xa (anti-Xa) assays or heparin titration systems improve assessment when available. Management is stepwise: UFH dose escalation; targeted AT supplementation (or fresh frozen plasma where concentrates are unavailable); and transition to direct thrombin inhibitors when HR persists or UFH is contraindicated. Protocolized pathways and multidisciplinary coordination reduce delays and adverse events. Conclusions: HR is a multifactorial, common challenge in CPB. Pre-bypass risk assessment, multimodal monitoring, and an algorithm prioritizing UFH optimization, AT repletion, and timely use of direct thrombin inhibitors provide a pragmatic framework to limit thrombosis and bleeding. Harmonized definitions and comparative trials remain priorities.
Keywords: heparin resistance; unfractionated heparin; cardiopulmonary bypass; activated clotting time; antithrombin; bivalirudin; argatroban heparin resistance; unfractionated heparin; cardiopulmonary bypass; activated clotting time; antithrombin; bivalirudin; argatroban

Share and Cite

MDPI and ACS Style

Rivera Jiménez, K.E.; Mamani Ticona, Y.M.; Gutierrez-Chavez, G.; Astudillo, C.O.; Calle, E.; Heredia, G.A.T.; Lopez Delgado, D.S.; Rivera-Lozada, O.; Barboza, J.J. Heparin Resistance in Cardiac Surgery with Cardiopulmonary Bypass: Mechanisms, Clinical Implications, and Evidence-Based Management. Medicina 2025, 61, 2088. https://doi.org/10.3390/medicina61122088

AMA Style

Rivera Jiménez KE, Mamani Ticona YM, Gutierrez-Chavez G, Astudillo CO, Calle E, Heredia GAT, Lopez Delgado DS, Rivera-Lozada O, Barboza JJ. Heparin Resistance in Cardiac Surgery with Cardiopulmonary Bypass: Mechanisms, Clinical Implications, and Evidence-Based Management. Medicina. 2025; 61(12):2088. https://doi.org/10.3390/medicina61122088

Chicago/Turabian Style

Rivera Jiménez, Karina E., Yahaira M. Mamani Ticona, Giancarlo Gutierrez-Chavez, Cristian O. Astudillo, Edisson Calle, Giancarlo A. Torres Heredia, Dario S. Lopez Delgado, Oriana Rivera-Lozada, and Joshuan J. Barboza. 2025. "Heparin Resistance in Cardiac Surgery with Cardiopulmonary Bypass: Mechanisms, Clinical Implications, and Evidence-Based Management" Medicina 61, no. 12: 2088. https://doi.org/10.3390/medicina61122088

APA Style

Rivera Jiménez, K. E., Mamani Ticona, Y. M., Gutierrez-Chavez, G., Astudillo, C. O., Calle, E., Heredia, G. A. T., Lopez Delgado, D. S., Rivera-Lozada, O., & Barboza, J. J. (2025). Heparin Resistance in Cardiac Surgery with Cardiopulmonary Bypass: Mechanisms, Clinical Implications, and Evidence-Based Management. Medicina, 61(12), 2088. https://doi.org/10.3390/medicina61122088

Article Metrics

Article metric data becomes available approximately 24 hours after publication online.
Back to TopTop