Antiphospholipid Syndrome: A Series of Surgical Emergencies and the Current Evidence for its Management

Agaba, AE; Charaklias, N; Babu-Victor, A; Agaba, PO; Deepchand, V; Dabasia, HS; Sharma, Shivani; Goodrick, MJ; Ramanand, B

doi:10.1308/003588406x106496

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…However, the effectiveness of low-dose aspirin as the primary prevention therapy for APS remains unproven. Clopidogrel has anecdotally been reported to be helpful in individuals with APS and may be useful in patients allergic to aspirin (24). In patients with SLE, hydroxychloroquine is also considered to be helpful as it has intrinsic antithrombotic properties (25).…”

Section: Discussionmentioning

confidence: 99%

Epigallocatechin-3-gallate inhibits TF and TNF-α expression induced by the anti-β2GPI/β2GPI complex in human THP-1 cells

Wang

Zhou

Xie

et al. 2014

International Journal of Molecular Medicine

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Epigallocatechin-3-gallate (EGCG) is the major polyphenolic component of green tea. The aim of the current study was to investigate the inhibitory effects of EGCG on anti-β2-glycoprotein I (β2GPI)/β2GPI-induced tissue factor (TF) and tumor necrosis factor-α (TNF-α) expression in the human acute monocytic leukemia cell line, THP-1, as well as the underlying mechanisms. Human THP-1 cells cultured in vitro were treated with lipopolysaccharide (LPS, 500 ng/ml) or with the anti-β2GPI (10 µg/ml)/β2GPI (100 µg/ml) complex following pre-treatment with or without EGCG (0-50 µg/ml). The expression levels of TF, TNF-α and Toll-like receptor 4 (TLR4) were measured, and the activation of mitogen-activated protein kinases (MAPKs) including p38, extracellular signal-regulated kinase 1/2 (ERK1/2) and c-Jun N-terminal kinase (JNK), and the nuclear factor-κB (NF-κB) signaling pathway was determined by western blot analysis. The results revealed that the anti-β2GPI/β2GPI complex activated the THP-1 cells, resulting in the enhanced expression of the coagulation cytokine, TF, as well as that of the pro-inflammatory cytokine, TNF-α; these levels were almost comparable to those induced by LPS. Pre-treatment with EGCG decreased the TF and TNF-α levels in the THP-1 cells treated with the anti-β2GPI/β2GPI complex in a dose-dependent manner and counteracted the upregulation of TLR4 expression (mRNA and protein) which was induced by the anti-β2GPI/β2GPI complex or LPS. Furthermore, EGCG suppressed the phosphorylation of p38, ERK1/2 and JNK and blocked the activation of the NF-κB signaling pathway induced by the anti-β2GPI/β2GPI complex or LPS. In conclusion, our results indicate that EGCG decreases the anti-β2GPI/β2GPI-induced TF and TNF-α expression in THP-1 cells possibly through the inhibition of the intracellular signal transduction pathway of TLRs-MAPKs-NF-κB axis and may serve as a preventive and therapeutic agent for antiphospholipid syndrome (APS).

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Section: Discussionmentioning

confidence: 99%

Epigallocatechin-3-gallate inhibits TF and TNF-α expression induced by the anti-β2GPI/β2GPI complex in human THP-1 cells

Wang

Zhou

Xie

et al. 2014

International Journal of Molecular Medicine

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“…IVC filer placement may be considered when patients with lower extremity DVT show active bleeding or recurrent DVT. 52,66 Intraoperative considerations Intraoperative management. A general anaesthesia or neuraxial anaesthesia, such as spinal, epidural, or combined spinal epidural anaesthesia, can be performed.…”

Section: Preoperative Considerationsmentioning

confidence: 99%

“…IVC filer placement may be considered when patients with lower extremity DVT show active bleeding or recurrent DVT. 52,66…”

Section: Anaesthetic Considerationsmentioning

confidence: 99%

Anaesthetic considerations for patients with antiphospholipid syndrome undergoing non-cardiac surgery

Kim

Ryu

et al. 2020

J Int Med Res

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Antiphospholipid syndrome (APS) is an acquired thrombotic autoimmune disorder that is clinically characterized by the development of thrombosis and obstetric morbidities in patients with antiphospholipid antibodies. Due to hypercoagulability, the focus of management is anticoagulation for the prevention of thrombosis and its recurrence. When such patients undergo surgery, however, the underlying risk of thrombosis increases as a result of anticoagulant withdrawal, immobilization, and/ or intimal injury. Conversely, there is also an increased risk of bleeding due to thrombocytopaenia, possible disseminated intravascular coagulation, or progression to catastrophic APS, as a result of excessive anticoagulation, surgery, and infection. Measures for appropriate perioperative anticoagulation are discussed in this review, as well as anaesthetic considerations for preventing perioperative complications in patients with APS undergoing non-cardiac surgery.

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Implantation of a Left Ventricular Assist Device in a Patient With Primary Antiphospholipid Syndrome

Meyer

Kuehn

Gras

et al. 2008

The Annals of Thoracic Surgery

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Antiphospholipid Syndrome: A Series of Surgical Emergencies and the Current Evidence for its Management

Cited by 5 publications

References 22 publications

Epigallocatechin-3-gallate inhibits TF and TNF-α expression induced by the anti-β2GPI/β2GPI complex in human THP-1 cells

Epigallocatechin-3-gallate inhibits TF and TNF-α expression induced by the anti-β2GPI/β2GPI complex in human THP-1 cells

Anaesthetic considerations for patients with antiphospholipid syndrome undergoing non-cardiac surgery

Implantation of a Left Ventricular Assist Device in a Patient With Primary Antiphospholipid Syndrome

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