Key result
Low Antithrombin III levels were present in 42% of post-cardiac surgery patients and showed a significant negative correlation with achieving therapeutic anticoagulation targets on the second day of heparin therapy.
Why the study?
Heparin resistance due to ATIII deficiency is common among post-cardiac surgery patients, but evidence regarding the prevalence of low ATIII levels and its correlation with unfractionated heparin response is limited.
Does low Antithrombin III level affect heparin efficacy in post-cardiac surgery patients?
Cohort (n=100)
No
Does low Antithrombin III level affect heparin efficacy in post-cardiac surgery patients?
Low antithrombin III levels are highly prevalent in post-cardiac surgery patients and paradoxically correlate with achieving higher therapeutic anticoagulation targets early after surgery.
Low ATIII may impair early heparin response post-cardiac surgery; hypothesis-generating for monitoring or repletion trials.
Background: Antithrombin III (ATIII) is a plasma protein that prevents stimulated clotting factors from functioning. Heparin binds to ATIII and potentiates its anticoagulant action by inactivating thrombin pro-coagulant activity. Heparin resistance due to ATIII deficiency is common among post-cardiac surgery patients, but limited evidence concerning the prevalence of low ATIII levels in such patients exists. Objective: The main objective of this study was to investigate the prevalence of low ATIII levels among post-cardiac surgery patients and assess ATIII's correlation with the anticoagulant response of unfractionated heparin (UFH). Methods: This study was a retrospective cohort study for which all patients who underwent cardiac surgery from May 2008 to May 2018 at our center were screened. ATIII deficiency was defined as plasma ATIII levels <60%. Results: We screened 300 adult patients who underwent cardiac surgery during the study period, and 100 out of the 300 patients fulfilled the selection criteria. The prevalence rate of low ATIII was 42/100 (42%) with a mean level of 64.7% 27.6%. Among the 67 patients who received UFH, the correlation between lower ATIII levels and higher coagulation parameters on day 1 of heparin therapy was negative but not significant (p 0.05). On day 2, there was significant negative correlation (p < 0.05), lower ATIII level indicated a tendency to achieve higher aPTT, aPTT ratio, and anti-Xa, with a modest magnitude of correlation (38%, 37%, and 47%, respectively). After 72 h, this correlation disappeared. Majority of the patients 41/67 (61.2%) achieved target aPTT ratio during the first 48 hrs. Heparin resistance was reported in 5/67 (7.5%).
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Al‐Jazairi et al. (2024) conducted a cohort in Post-cardiac surgery (n=100). Low Antithrombin III (ATIII) level (<60%) vs. Normal Antithrombin III level (≥60%) was evaluated on Prevalence of Antithrombin III (ATIII) deficiency (plasma levels <60%). Low Antithrombin III levels were present in 42% of post-cardiac surgery patients and showed a significant negative correlation with achieving therapeutic anticoagulation targets on the second day of heparin therapy.
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