title: 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.
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK mishrapk_25@yahoo.com.
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Mishra
authors.affiliation: Department of Cardiothoracic Anaesthesia, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: Fayaz Mohammed
authors.initials: FM
authors.lastname: Khazi
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Yiu
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: John Stephen
authors.initials: JS
authors.lastname: Billing
mesh_terms: D000328:Adult; D000465:Algorithms; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D057915:Drug Substitution; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin
keywords: Anticoagulants; antiphospholipid syndrome; blood coagulation tests; cardiopulmonary bypass; heart valve prosthesis implantation