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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Evaluation of Antithrombin III Utilization in Cardiovascular Surgery Requiring Cardiopulmonary Bypass—A Retrospective Review of Institutional Practice Ekaterina Pechenko1, Jen Osborn1, Josh Breeding2, Vrushali Pachpande1. 1M Health Fairview University of Minnesota Medical Center, Minneapolis, MN, USA.2M Health Fairview Southdale Hospital, Edina, MN, USA |
Abstract
Background: Antithrombin III (AT) is a critical serine protease inhibitor that enhances heparin-mediated anticoagulation during cardiopulmonary bypass (CPB). Acquired AT deficiency during CPB—due to hemodilution, consumption, and circuit adsorption—can lead to heparin resistance, defined as failure to achieve an activated clotting time (ACT) >/= 480 seconds despite >500 units/kg of unfractionated heparin. AT concentrate (ATc) is FDA-approved for managing heparin resistance in cardiac surgery; however, recent evidence questions its routine use. While AT supplementation improves laboratory markers (AT activity, heparin sensitivity), randomized trials and meta-analyses have shown no reduction in bleeding or transfusion requirements and have raised safety concerns, including increased acute kidney injury (AKI) and mortality. Objectives: to evaluate the utilization, efficacy, and safety of ATc in cardiovascular surgeries requiring CPB by examining dosing strategies and criteria for use, assessing ATc impact on achieving target ACT (>/= 480 seconds), and analyzing safety outcomes. Methods: This retrospective cohort study will include adult patients >/= 18 years who underwent cardiac surgery requiring CPB and received ATc between January 1, 2022, and October 31, 2025, at M Health Fairview hospitals. Data collected will include demographics (age, sex, weight, and BMI), comorbidities (hypertension, diabetes, liver disease, prior thromboembolism), surgical type and urgency, baseline laboratory parameters (INR, PTT, anti-Xa, platelet count, AT activity, hemoglobin, serum creatinine), and preoperative anticoagulation. Perioperative details will include heparin dosing in units/kg, dose of ATc administered, ACT measurements before and after ATc administration, and timing of CPB initiation. The primary outcome is resolution of heparin resistance, defined as achieving ACT >/= 480 seconds after ATc administration. Secondary outcomes include in-hospital mortality, ICU length of stay, acute kidney injury (AKI), and incidence of bleeding events—measured by postoperative chest tube output in the first 12 hours, the number of packed red blood cell (pRBC) units transfused within 24 hours, and whether surgical re-exploration for bleeding occurred during hospitalization—as well as overall transfusion requirements (fresh frozen plasma [FFP], pRBC, platelets, 4-factor prothrombin complex concentrate, fibrinogen concentrate) and thromboembolic events (stroke, venous thromboembolism [VTE], myocardial infarction). Results: research in progress Conclusion: research in progress
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.