Manpreet Gill on Heparin Resistance: When 14 Years of Experience Finally Gets a Plot Twist
Manpreet Gill, Senior Consultant, Head of General and Cardiac Anaesthesia at Shalby Limited, shared on LinkedIn:
”Heparin Resistance: When 14 Years of Experience Finally Gets a Plot Twist
In 14 years of doing CTVS anesthesia, I had almost started believing that heparin resistance was one of those exam-only entities—nice to read about, great for viva discussions, but unlikely to walk into your OT unannounced.
Until last week.
57-year-old gentleman.
On-pump CABG.
Textbook plan.
Heparin… and more heparin… and some more.
ACT politely refused to cooperate.
No matter how much heparin we gave, ACT just sat there like:
“Nice try, doctor.”
That’s when reality kicked in—this wasn’t underdosing, faulty ACT, or bad karma. This was true heparin resistance, most likely due to low Antithrombin III.
Two units of FFP later, ACT behaved, bypass went smoothly, and the patient did well.
Take-home message for juniors (and seniors with selective memory):
1 Heparin resistance is not rare—it’s just rarely encountered personally.
2 More heparin is not always the answer.
3 Think AT-III deficiency early when ACT doesn’t rise as expected.
4 FFP can be a lifesaver when AT-III concentrate isn’t available.
Experience doesn’t prevent surprises—it just teaches you to stay calm when they arrive.
Medicine has a funny way of humbling us.
Just when you think you’ve “seen it all,” it sends a reminder saying:
“Revision never hurts.”
Stay curious. Stay prepared.
And always respect the ACT machine—it knows things.”
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