Anaesthetic Implications of the Anti-Cardiolipin Antibody Syndrome

Abstract

The anti-cardiolipin antibody syndrome (or anti-phospholipid antibody syndrome) is characterized by the presence of autoantibodies to phospholipids. Its major association is with systemic lupus erythematosus. It is characterized further by in vitro prolongation of phospholipid-dependent coagulation tests. However, in vivo it is associated with a markedly increased incidence of thrombosis, both arterial and venous. We describe the case of a 36-yr-old female patient with the anti-cardiolipin antibody syndrome who presented initially for diagnostic laparoscopy and later for exploratory laparotomy. Her postoperative course after the first general anaesthetic was complicated by disseminated intravascular coagulation and adult respiratory distress syndrome. After the second operation, she deteriorated further with worsening cardiac, renal and respiratory function and eventually died. As far as we are aware, this is the first reported case of the anti-cardiolipin antibody syndrome in anaesthetic literature. Further aspects of this puzzling condition and its anaesthetic implications are discussed.

Epidural blood patch for atypical headache following obstetric epidural analgesia

“…It is known that these patients can develop thrombosis despite receiving heparin [23] and this was demonstrated by both patients. A dose of heparin of 10 000-15 000 U subcutaneously proved not to be adequate for perioperative thromboprophylaxis in the second patient.…”

Anesthetic implications of the catastrophic antiphospholipid syndrome

“…The perioperative management of patients with CAPS in children focuses on prevention of factors predisposing to thrombosis such as immobilization, use of anti‐embolic stockings, avoiding dehydration and maintaining normothermia and treatment of infections, even trivial (11). Great care should be taken by the attending anesthesiologist/surgeon to ensure that the patient is adequately covered during the surgical procedures with parenteral anticoagulation, and if anticoagulation has to be discontinued for any reason, the unprotected period should be kept as short as possible (12).…”

Prevention of thrombosis with prostaglandin E1 in a patient with catastrophic antiphospholipid syndrome

“…4 However, the thrombotic tendency is temporarily enhanced by surgical procedures and the discontinuation of anticoagulant treatment. 2,[8][9][10][11] The intraoperative management for cancer resection is challenging because of the competing risks of complications: exacerbation of thrombosis triggered by surgery vs significant bleeding due to anticoagulation. In this report, we describe the intraoperative use of prostaglandin E 1 (PGE 1 ) as an antithrombotic agent in a patient with cancer-related CAPS.…”

“…[4][5][6] In this patient, the catastrophic symptoms of multiorgan failure associated with both arterial and venous thromboembolism, positive anticardiolipin IgG antibodies, and the presence of a pelvic mass consistent with a cancer suggested the diagnosis. Although surgery enhances the thrombotic tendency in APS, [8][9][10][11] surgical removal of the cancer is regarded as the only treatment to eliminate thromboembolism and APA. 4 The anesthetic management of APS associated with autoimmune diseases has been reported previously.…”

“…4 The anesthetic management of APS associated with autoimmune diseases has been reported previously. 8,12 As far as we know, however, there has been no reported case of cancer-related CAPS in the anesthetic literature. In this case, the ovarian cancer was resected uneventfully with the use of PGE 1 and placement of an inferior vena cava filter, in spite of the potential risks of developing thromboembolism triggered by the surgical procedure or significant bleeding during surgery.…”