title: Perioperative anticoagulation management in antiphospholipid syndrome.
abstract: Patients with antiphospholipid syndrome are at increased risk of developing thrombotic and hemorrhagic complications after cardiac surgery, and may have abnormal coagulation tests and develop thrombocytopenia after invasive procedures, which can complicate the perioperative management of anticoagulant therapy. We describe a patient with chronic thromboembolic pulmonary hypertension and antiphospholipid syndrome, who presented with prolonged activated partial thromboplastin and activated clotting times, and developed thrombocytopenia after the catheterization workup. We performed pulmonary endarterectomy and successfully managed anticoagulation by restricting heparin use at the time of surgery and monitoring the heparin effect by measuring heparin concentrations during cardiopulmonary bypass.
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan keiichi-ishida@pro.odn.ne.jp.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ishida
authors.affiliation: Department of Cardiovascular Surgery, Chiba Medical Center, Chiba, Japan.
authors.forename: Masahisa
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kohno
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Yusaku
authors.initials: Y
authors.lastname: Tamura
authors.affiliation: Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Goro
authors.initials: G
authors.lastname: Matsumiya
mesh_terms: D000328:Adult; D000792:Angiography / Q000379:methods; D000925:Anticoagulants / Q000008:administration & dosage; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications; D001780:Blood Coagulation Tests / Q000379:methods; D002407:Catheterization, Swan-Ganz / Q000379:methods*; D018890:Chemoprevention / Q000379:methods; D016903:Drug Monitoring / Q000379:methods; D004691:Endarterectomy / Q000379:methods*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D019990:Perioperative Care / Q000379:methods; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D013921:Thrombocytopenia / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Anticoagulants; Antiphospholipid syndrome; Blood coagulation tests; Drug monitoring; Endarterectomy; Heparin