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

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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Copyright © 2023 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interests J.H.L. is on Advisory or Steering Committees for Merck, Octapharma, Takeda, and Werfen; R.M.S. reports research support from Grifols and Cerus corporations, and is on the advisory board for OctaPharma; K.G. reports research support from Octapharma and the Patient-Centered Outcomes Research Institute; J.D. serves on advisory committees for Pfizer, Sanofi, Leo Pharma, Bristol-Myers Squibb, Portola, and Janssen; C.F. reports honoraria for lectures from Bristol Myers Squibb, Bayer, and Leo Pharma; J.H. reports honoraria from Asahi Kasei, Diagnostica Stago, Pfizer PFE France, Sanofi Aventis France, Inotrem, MSD, and Shionogi; T.I. reports research grant from Japan Blood Products Organization; M.D.N. is the Chief Medical Officer of Haima Therapeutics and reports research funding from the National Institutes of Health, Department of Defense, Defense Advanced Research Projects Agency, Instrumentation Laboratories, Haemonetics, and Alexion; A.S. reports a research grant from Janssen and honoraria from Janssen, Sanofi, and Alexion; A.J.T. reports educational grants from Janssen Research, Doasense, Janssen, BMS, Idorsia, Anthos, Novartis, BioTap, and Stago; K.A.T. reports research funding from Instrumentation Laboratory, CSL Behring, and Octapharma data safety committee; J.M.C. reports Scientific Ad Boards and Consulting from Abbott, Anthos, BMS, Pfizer, Roche, Sanofi, and Werfen; B.R., A.K., T.K.L., C.L.M., E.S., and M.E.S. report no conflict of interests.