Severe antiphospholipid syndrome and cardiac surgery: Perioperative management

Abstract

Antiphospholipid syndrome is an antiphospholipid antibody-mediated prothrombotic state leading to arterial and venous thrombosis. This condition alters routine in-vitro coagulation tests, making results unreliable. Antiphospholipid syndrome patients requiring cardiac surgery with cardiopulmonary bypass present a unique challenge in perioperative anticoagulation management. We describe 3 patients with antiphospholipid syndrome who had successful heart valve surgery at our institution. We have devised an institutional protocol for antiphospholipid syndrome patients, and all 3 patients were managed according to this protocol. An algorithm-based approach is recommended because it improves team work, optimizes treatment, and improves patient outcome.

Keywords

Anticoagulants antiphospholipid syndrome blood coagulation tests cardiopulmonary bypass heart valve prosthesis implantation

Get full access to this article

View all access options for this article.

References

Koniari I, Siminelakis SN, Baikoussis NG, Papadopoulos G, Goudevenos J, Apostolakis E. Antiphospholipid syndrome; its implication in cardiovascular diseases: a review. J Cardiothorac Surg 2010 Nov 3; 5: 101. doi: 10.1186/1749-8090-5-101.

Hegde VAP, Vivas Y, Shah H, Haybron D, Srinivasan V, Dua A, Gradman A. Cardiovascular surgical outcomes in patients with the antiphospholipid syndrome -a case-series. Heart Lung Circ 2007 Dec; 16(6): 423–7.

Sakaguchi G, Minami K, Nakayama S, Tsuneyoshi H. Aortic valve replacement after previous coronary artery bypass grafting in a patient with antiphospholipid syndrome. Jpn J Thorac Cardiovasc Surg 1998 Mar; 46(3): 257–9.

Gorki H1, Malinovski V, Stanbridge RD. The antiphospholipid syndrome and heart valve surgery. Eur J Cardiothorac Surg 2008 Feb; 33(2): 168–81.

Weiss S1, Nyzio JB, Cines D, Detre J, Milas BL, Narula N, Floyd TF. Antiphospholipid syndrome: intraoperative and postoperative anticoagulation in cardiac surgery. J Cardiothorac Vasc Anesth 2008 Oct; 22(5): 735–9.

Despotis GJ, Joist JH, Hogue CW Jr, Alsoufiev A, Kater K, Goodnough LT, Santoro SA, Spitznagel E, Rosenblum M, Lappas DG. The impact of heparin concentration and activated clotting time monitoring on blood conservation. A prospective, randomized evaluation in patients undergoing cardiac operation. J Thorac Cardiovasc Surg 1995 Jul; 110(1): 46–54.

Dornan RI. Acute postoperative biventricular failure associated with antiphospholipid antibody syndrome. Br J Anaesth 2004 May; 92(5): 748–54.

Sheikh F, Lechowicz A, Setlur R, Rauch A, Dunn H. Recognition and management of patients with antiphospholipid antibody syndrome undergoing cardiac surgery. J Cardiothorac Vasc Anesth 1997 Oct; 11(6): 764–6.

East CJ, Clements F, Mathew J, Slaughter TF. Antiphospholipid syndrome and cardiac surgery: management of anticoagulation in two patients. Anesth Analg 2000 May; 90(5): 1098–101.