[Antiphospholipid antibody syndrome in pediatric neurosurgery: a hemostasis problem].
The case of a 11-year-old boy under anticoagulant therapy for a familial antiphospholipid antibody syndrome (SAAPF), who underwent surgery for a cerebrovascular malformation responsible for an intracerebral haematoma, is reported. Antivitamins K (AVK) were changed for unfractioned heparin (HNF), three days before. Heparin was discontinued two hours prior to surgery to obtain a normal peroperative coagulation. A vascular dural fistula was removed without any haemostatic problem. The neurological status rapidly returned to normal and tomodensitometry at day 1 showed a normal intracranial status. Heparin was readministered at h 16. Thrombocytopenia occurred at day 4 of heparin treatment. The change for a low weight molecular heparinoid, danaparoid (Orgaran), normalized the platelet count. The platelets aggregation tests were negative during thrombopenia. However, the test for antibodies against the PF4-heparin complex with the Elisa technique, was in favour of a heparin induced thrombocytopenia (TIH). In spite of its anecdotic occurrence due to cumulative thrombotic risks from the association of immunologic disorders (TIH and SAAPF), this case report underlines the value but also the risks of anticoagulant therapy in neurosurgery, when patients are at high risk for thrombosis.
Bocquet
R
R
Département d'anesthésie-réanimation chirurgicale, hôpital Necker-Enfants-Malades, Paris, France.
Blanot
S
S
Dautzenberg
M D
MD
Pierre-Kahn
A
A
Carli
P
P
D016736:Antiphospholipid Syndrome / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000601:surgery*; D002648:Child; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D013921:Thrombocytopenia / Q000209:etiology*