Antiphospholipid syndrome; its implication in cardiovascular diseases: a review

Abstract

Antiphospholipid syndrome (APLS) is a rare syndrome mainly characterized by several hyper-coagulable complications and therefore, implicated in the operated cardiac surgery patient. APLS comprises clinical features such as arterial or venous thromboses, valve disease, coronary artery disease, intracardiac thrombus formation, pulmonary hypertension and dilated cardiomyopathy. The most commonly affected valve is the mitral, followed by the aortic and tricuspid valve. For APLS diagnosis essential is the detection of so-called antiphospholipid antibodies (aPL) as anticardiolipin antibodies (aCL) or lupus anticoagulant (LA). Minor alterations in the anticoagulation, infection, and surgical stress may trigger widespread thrombosis. The incidence of thrombosis is highest during the following perioperative periods: preoperatively during the withdrawal of warfarin, postoperatively during the period of hypercoagulability despite warfarin or heparin therapy, or postoperatively before adequate anticoagulation achievement. Cardiac valvular pathology includes irregular thickening of the valve leaflets due to deposition of immune complexes that may lead to vegetations and valve dysfunction; a significant risk factor for stroke. Patients with APLS are at increased risk for thrombosis and adequate anticoagulation is of vital importance during cardiopulmonary bypass (CPB). A successful outcome requires multidisciplinary management in order to prevent thrombotic or bleeding complications and to manage perioperative anticoagulation. More work and reporting on anticoagulation management and adjuvant therapy in patients with APLS during extracorporeal circulation are necessary.

Neurofibromatosis type I and anti-phospholipid antibody syndrome: Report of one case

“…APS, also known as Lupus anticoagulans syndrome, is an autoimmune coagulation disorder due to the production of auto-antibodies against phospholipids in membranes, cardiolipin, or β2-glycoprotein 1 8 . APS is characterized by thrombus formation in arteries and veins, manifesting clinically as deep venous thrombosis, ischemic stroke, miscarriage prior to the 10 th week of gestation, pre-eclampsia after the 20 th week of gestation, or stillbirth (Table 1) 9 . APS may be primary, without other concomitant disease, or secondary, if in conjunction with other autoimmune disorders 1,10 .…”

Pulmonary Hypertension Is a Probable NO/ONOO−Cycle Disease: A Review

“…Systemic autoimmune diseases, including systemic lupus erythematosis, systemic sclerosis and antiphospholipid syndrome are associated with greatly increased incidence of PAH [148][149][150][151]. Such autoimmune diseases are well known to increase the in�ammatory parts of the cycle, including NF-B in�ammatory cytokine, and iNOS induction with these leading, in turn, to elevate ONOO − and oxidative stress [152].…”

How to improve our ability to predict adverse events in major surgery of SLE patients?

“…In conclusion, a multidisciplinary assessment in evaluating critical SLE patients is mandatory when surgical treatment is planned, particularly if it is a matter of major surgery [12]. Perhaps, time has come for a worldwide challenge to create an updated score to quantify damage in SLE patients [13].…”