title: Bivalirudin anticoagulation for minimal invasive transapical transcatheter aortic valve replacement in a patient with antiphospholipid antibodies.
abstract: The occurrence of lupus anticoagulant is associated with the hazard of developing an antiphospholipid syndrome, a severe prothrombotic condition which may particularly occur after major surgical trauma. This disease requires certain considerations regarding surgical strategy and anticoagulation management. We describe the perioperative management of a patient scheduled for elective aortic valve replacement and diagnosed for having antiphospholipid antibodies. The procedure was successfully performed using a minimally invasive approach via transapical aortic valve replacement and anticoagulation with the nonreversible short-acting direct thrombin Inhibitor bivalirudin.
authors.affiliation: Institute of Anesthesiology, Heart and Diabetes Center NRW, Bad Oeynhausen, Ruhr-University Bochum, Germany. Electronic address: akoster@hdz-nrw.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Koster
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Ruhr-University Bochum, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ensminger
authors.affiliation: Department of Cardiology, Heart and Diabetes Center NRW, Bad Oeynhausen, Ruhr-University Bochum, Germany.
authors.forename: Marios
authors.initials: M
authors.lastname: Vlachojannis
authors.affiliation: Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Center NRW, Bad Oeynhausen, Ruhr-University Bochum, Germany.
authors.forename: Ingvild
authors.initials: I
authors.lastname: Birschmann
mesh_terms: D000368:Aged; D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000150:complications*; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D006328:Cardiac Catheterization; D006629:Hirudins; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010446:Peptide Fragments / Q000627:therapeutic use*; D019990:Perioperative Care; D011994:Recombinant Proteins / Q000627:therapeutic use; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
chemical_list: D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: Cardiac surgery; Lupus anticoagulant; Thrombosis