Author(s)

Kang Du ¹

Affiliation(s)

¹ Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

Corresponding Author

Kang Du

ABSTRACT

Heparin resistance during cardiac surgery is uncommon, and its occurrence in patients with left atrial myxoma is rare. The mechanism likely involves glycosaminoglycans released from myxomatous tissue competing with heparin for antithrombin III binding, combined with possible antithrombin III deficiency. We describe a 60-year-old woman who developed severe heparin resistance during video-assisted thoracoscopic resection of a left atrial myxoma. After standard unfractionated heparin dosing, her activated clotting time remained below 480 seconds despite a cumulative dose of 717 IU/kg. Rapid transfusion of 450 mL fresh frozen plasma achieved a therapeutic activated clotting time of 497 seconds, and cardiopulmonary bypass proceeded without complication. On postoperative day 1, she had transient coagulopathy with prolonged activated partial thromboplastin time and prothrombin time, low fibrinogen, and mildly reduced antithrombin III, but no clinical bleeding. These abnormalities resolved by postoperative day 2 without treatment. She was discharged on day 7 in stable condition. Anesthesia teams should anticipate heparin resistance in cardiac myxoma surgery and have blood products available before heparin administration. Fresh frozen plasma can serve as effective rescue therapy when heparin alone does not achieve therapeutic anticoagulation.

KEYWORDS

Heparin resistance; Left atrial myxoma; Cardiopulmonary bypass; Fresh frozen plasma; Video-assisted thoracoscopic surgery

CITE THIS PAPER

Kang Du. Massive Heparin Resistance During Cardiopulmonary Bypass for Left Atrial Myxoma Resection Complicated by Postoperative Coagulopathy. MEDS Clinical Medicine (2026). Vol. 7, No.2, 155-160. DOI: http://dx.doi.org/10.23977/medsc.2026.070219.

REFERENCES

[1] Velez Torres JM, Martinez Duarte E, Diaz-Perez JA, Rosenberg AE. Cardiac myxoma: review and update of contemporary immunohistochemical markers and molecular pathology. Adv Anat Pathol. 2020;27:380-384.
[2] Ashinze P, Banerjee S, Egbunu E, et al. Cardiac myxomas: a review of current treatment approaches and emerging molecular therapies. Cardiothorac Surg. 2024;32:29.
[3] Pinede L, Duhaut P, Loire R. Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. Medicine (Baltimore). 2001;80(3):159-172.
[4] Levy JH, Connors JM. Heparin resistance - clinical perspectives and management strategies. N Engl J Med. 2021;385:e31.
[5] Finley A, Greenberg C. Heparin sensitivity and resistance: management during cardiopulmonary bypass. Anesth Analg. 2013;116:1210-1222.
[6] Phoon PHY, Tan MEA, Ng R, et al. Heparin resistance during cardiopulmonary bypass in adult cardiac surgery. J Cardiothorac Vasc Anesth. 2022;36:2696-2706.
[7] Liu H, Hu R. Preliminary observation on heparin relative resistance in patients with left atrial myxoma. Chin Circ J. 1991;6:2.
[8] Butt SP, Kakar V, Kumar A, et al. Heparin resistance management during cardiac surgery: a literature review and future directions. J Extra Corpor Technol. 2024;56:3.
[9] EACTS/EACTAIC/EBCP Guidelines on anticoagulation and antithrombotic strategies in extracorporeal circulation. Eur J Cardiothorac Surg. 2024.
[10] Koster A, Dyke CM, Aldea G, et al. Bivalirudin during cardiopulmonary bypass in patients with previous or acute heparin-induced thrombocytopenia and heparin antibodies. Ann Thorac Surg. 2007;83(2):572-577.
[11] Houston E, Ludman P, McCready J, et al. Massive atrial myxoma requiring emergency cardiopulmonary bypass in a patient with heparin resistance. Anaesth Rep. 2020;8:103-106.
[12] Cohn LH. Minimally invasive valve surgery. J Card Surg. 2001;16(3):260-265.
[13] Despotis GJ, Summerfield AL, Joist JH, et al. Comparison of activated coagulation time and whole blood heparin measurements with laboratory plasma anti-Xa heparin concentration in patients having cardiac operations. J Thorac Cardiovasc Surg. 1994;108(6):1076-1082.
[14] Harker LA, Malpass TW, Branson HE, et al. Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: acquired transient platelet dysfunction associated with selective alpha-granule release. Blood. 1980;56(5):824-834.

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