title: Bridging therapy in antiphospholipid syndrome and antiphospholipid antibodies carriers: case series and review of the literature.
abstract: Peri-operative management of patients on warfarin involves assessing and balancing individual risks for thromboembolism and bleeding. The timing of warfarin withdrawal and a tailored pre/postoperative management (including the substitution of heparin in place of warfarin, the so-called bridging therapy) is critical in patients with prothrombotic conditions. The antiphospholipid syndrome (APS) is the most common cause of acquired thrombophilia. In this particular subset of patients, as the risk of thrombosis is higher than in general population, bridging therapy can represent a real challenge for treating physicians. Only few studies have been designed to address this topic. We aim to report our experience and to review the available literature in the peri-procedural management of APS and antiphospholipid antibody-positive patients, reporting adverse events and attempting to identify potential risk factor associated with thrombosis or bleeding complications.
authors.affiliation: Clinical Immunology, AO Ordine Mauriziano, Torino, Italy.
authors.forename: Samuele
authors.initials: S
authors.lastname: Raso
authors.affiliation: Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare and Università di Torino, Torino, Italy; Graham Hughes Lupus Research Laboratory, King's College London, London, UK. Electronic address: savino.sciascia@unito.it.
authors.forename: Savino
authors.initials: S
authors.lastname: Sciascia
authors.affiliation: Clinical Immunology, AO Ordine Mauriziano, Torino, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Kuzenko
authors.affiliation: Clinical Immunology, AO Ordine Mauriziano, Torino, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Castagno
authors.affiliation: Department of Obstetrics and Gynaecology, Università di Torino, Torino, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Marozio
authors.affiliation: Clinical Immunology, AO Ordine Mauriziano, Torino, Italy.
authors.forename: Maria Tiziana
authors.initials: MT
authors.lastname: Bertero
mesh_terms: D017152:Antibodies, Antiphospholipid / Q000032:analysis; D000925:Anticoagulants / Q000008:administration & dosage*; D016736:Antiphospholipid Syndrome / Q000188:drug therapy* / Q000276:immunology; D006470:Hemorrhage / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D059035:Perioperative Period; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin
keywords: Anticoagulation; Antiphospholipid syndrome; Bleeding; Bridging therapy; Thrombosis; Warfarin