Treating heparin resistance with antithrombin or fresh frozen plasma

Heparin resistance occurs in up to 22% of patients undergoing cardiac surgery requiring cardiopulmonary bypass and it is associated with decreased levels of antithrombin. Treatment options for heparin resistance include administration of antithrombin or fresh frozen plasma. A systematic review revealed no clinical trials directly comparing antithrombin with fresh frozen plasma as heparin resistance treatment during cardiopulmonary bypass. Thus, the aim of this review is to discuss the limited number of published reports assessing antithrombin or fresh frozen plasma in managing heparin resistance and to present emerging data regarding fresh frozen plasma safety issues and practical considerations for antithrombin treatment in patients with heparin resistance undergoing cardiopulmonary bypass.