Heparin resistance in a patient with severe acute pancreatitis: a case report.

Introduction: Severe acute pancreatitis is a life-threatening condition characterized by systemic inflammatory response syndrome and an increased risk of complications such as venous thrombosis, all of which contributes to a high mortality rate. Heparin resistance, although rare, can lead to ineffective anticoagulation and thrombus formation during unfractionated heparin therapy, complicating management.

Methods: We report a case of heparin resistance in which, despite increasing the unfractionated heparin dosage, the patient's activated partial thromboplastin time remained subtherapeutic.

Results: Laboratory findings indicated normal antithrombin levels but undetectable anti-Xa activity, confirming non-antithrombin-mediated heparin resistance. A multidisciplinary approach led to the successful management of thrombosis with rivaroxaban, resulting in substantial clinical improvement.

Discussion: This case highlights the importance of early recognition and management of heparin resistance in patients with severe acute pancreatitis. Combined monitoring of activated partial thromboplastin time and anti-Xa activity is crucial for optimizing anticoagulation therapy and preventing complications such as deep vein thrombosis.