Management of Perioperative Anticoagulation in a Patient With Antiphospholipid Antibody Syndrome Undergoing Cardiac Surgery: A Case Report

Authors

Sanjana A Malviya
Yi Deng
Sayyed O Gilani
Alec A Hendon
Melissa A Nikolaidis
Micah S Moseley

Publication Date

1-1-2022

Journal

Annals of Cardiac Anaesthesia

DOI

10.4103/aca.aca_228_20

PMID

35417972

PMCID

PMC9244265

PubMedCentral® Posted Date

4-11-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Anticoagulants, Antiphospholipid Syndrome, Aortic Valve, Blood Coagulation, Cardiac Surgical Procedures, Humans/, Antifibrinolytics, antiphospholipid syndrome, cardiopulmonary bypass, immune thrombocytopenic purpura, Libman-Sacks endocarditis

Abstract

Patients with Antiphospholipid syndrome (APLS) are at high risk for both bleeding and thrombotic complications during cardiac surgery involving cardiopulmonary bypass (CPB). In this case we present a patient with APLS and Immune Thrombocytopenic Purpura who successfully underwent aortic valve replacement (AVR) with CPB despite recent craniotomy for subdural hematoma evacuation. Anticoagulation for CPB was monitored by targeting an Activated Clotting Time (ACT) that was 2× the upper limit of normal. A multidisciplinary approach was essential in ensuring a safe and successful operation.