在接受需体外循环心脏手术的患者中，多达22%的患者都可能发生肝素耐药。这种情况与抗凝血酶水平下降相关。肝素耐药的治疗选择包括使用抗凝血酶或新鲜冷冻血浆。一项系统回顾显示，目前尚无临床试验直接比较抗凝血酶和新鲜冷冻血浆治疗心肺分流术中肝素耐药的疗效。为此，美国弗吉尼亚州里士满联邦大学的 Spiess BD对已发表的评价抗凝血酶或新鲜冷冻血浆治疗肝素耐药的研究进行了回顾，并讨论了在心肺分流术中发生肝素耐药的患者中应用新鲜冷冻血浆的安全性以及抗凝血酶治疗实际应用中需要考虑的问题。

Treating Heparin Resistance With Antithrombin or
Fresh Frozen Plasma
Bruce D. Spiess, MD, FAHA
Department of Anesthesiology, Virginia Commonwealth University Reanimation Engineering Shock Center, Richmond, Virginia

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.