Combined spinal-epidural anesthesia in a mild thrombocytopenic patient with antiphospholipid antibody syndrome

Kim, Ga Hyun; Sim, Hyunyee; Yang, Jaeyoung; Lee, Jong‐Hwan; Choi, Duck Hwan

doi:10.4097/kjae.2014.67.s.s100

Cited by 2 publications

(4 citation statements)

References 4 publications

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“…Theoretically, neuraxial blockade, including epidural analgesia, can be performed in patients with APS and aPL positivity, as a hypercoagulable state is the essential pathophysiology in such patients [ 6 ]. Additionally, in some patients receiving antithrombotic therapy, meticulously performed bridging anticoagulation allows the use of regional anesthesia [ 7 ]. Nevertheless, these procedures tend to be avoided in both emergency and elective settings; therefore, we aimed to discuss the implications of using epidural analgesia in an emergency patient with aPL positivity.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management Using Epidural Analgesia for Emergency Laparoscopic Cholecystectomy in a Patient with Lupus Anticoagulant Positivity and Prolonged Activated Partial Thromboplastin Time

Watanabe

Kaneda

2022

Case Reports in Anesthesiology

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Lupus anticoagulant (LA), an antiphospholipid antibody, prolongs in vitro activated partial thromboplastin time (APTT) despite the presence of a hypercoagulable state in vivo. Irrespective of whether they receive antithrombotic therapy, meticulous anesthetic management is imperative in patients with LA positivity to prevent thrombotic complication. Additionally, emergency surgery in such patients can be challenging, as the time to devise perioperative strategies is limited. Here, we described the case of a patient with LA positivity and prolonged APTT who underwent emergency laparoscopic cholecystectomy with successful anesthetic management using epidural analgesia. An 83-year-old woman presented with acute cholecystitis and underwent emergency laparoscopic cholecystectomy. Preoperative blood test results revealed a prolonged APTT of 83 s, prothrombin time/international normalized ratio of 1.14, and normal platelet count. The patient had experienced a marked prolongation of APTT ten years previously, which was attributed to LA positivity, and she had previously undergone surgery for rectal cancer under general and epidural anesthesia. The patient did not receive antithrombotic therapy, and she demonstrated neither liver dysfunction nor a bleeding tendency. We prioritized optimal analgesia to enable early mobilization; therefore, an epidural catheter was placed in preparation for transition to open abdominal surgery. The operation was completed under laparoscopy, and good pain control was achieved postoperatively with continuous epidural analgesia, facilitating early ambulation. The epidural catheter was removed on the second postoperative day, and the patient did not develop any signs of thromboembolism or neurologic complications during her hospital stay. Anesthetic management for emergency laparoscopic cholecystectomy was successfully performed using epidural analgesia in a patient with LA positivity and prolonged APTT. Careful evaluation of laboratory data, treatment history, and clinical symptoms is of critical importance in such patients.

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Section: Discussionmentioning

confidence: 99%

Anesthetic Management Using Epidural Analgesia for Emergency Laparoscopic Cholecystectomy in a Patient with Lupus Anticoagulant Positivity and Prolonged Activated Partial Thromboplastin Time

Watanabe

Kaneda

2022

Case Reports in Anesthesiology

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“…68,69 One case of safe and successful administration of combined spinal-epidural anaesthesia for caesarean section in a patient with APS having mild thrombocytopaenia (platelet count 85 000/ ml) has been reported. 67 Thus, even for patients other than pregnant women, if the benefits of neuraxial anaesthesia outweigh the risks relative to general anaesthesia, anaesthesiologists should be aware that neuraxial anaesthesia can be performed safely in patients with APS having appropriate perioperative anticoagulation and acceptable laboratory profiles.…”

Section: Preoperative Considerationsmentioning

confidence: 99%

“…Nevertheless, in pregnant women, neuraxial anaesthesia offers numerous maternal and fetal benefits compared with general anaesthesia, and is known to be relatively safe, and therefore, studies have investigated neuraxial anaesthesia in patients with APS. 54,67 As long as a deranged coagulation profile is not observed after holding preoperative anticoagulation for an appropriate duration, neuraxial anaesthesia can be safely performed to patients with APS, except in those scheduled to receive massive transfusion, or patients scheduled to undergo emergency surgery immediately after heparin administration. 37,67 If there is no problem with platelet function, data have shown that neuraxial anaesthesia may be safely performed on pregnant women with a platelet count of 80 000-100 000/ml.…”

Section: Introductionmentioning

confidence: 99%

“…54,67 As long as a deranged coagulation profile is not observed after holding preoperative anticoagulation for an appropriate duration, neuraxial anaesthesia can be safely performed to patients with APS, except in those scheduled to receive massive transfusion, or patients scheduled to undergo emergency surgery immediately after heparin administration. 37,67 If there is no problem with platelet function, data have shown that neuraxial anaesthesia may be safely performed on pregnant women with a platelet count of 80 000-100 000/ml. 68,69 One case of safe and successful administration of combined spinal-epidural anaesthesia for caesarean section in a patient with APS having mild thrombocytopaenia (platelet count 85 000/ ml) has been reported.…”

Section: Introductionmentioning

confidence: 99%

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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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Combined spinal-epidural anesthesia in a mild thrombocytopenic patient with antiphospholipid antibody syndrome

Cited by 2 publications

References 4 publications

Anesthetic Management Using Epidural Analgesia for Emergency Laparoscopic Cholecystectomy in a Patient with Lupus Anticoagulant Positivity and Prolonged Activated Partial Thromboplastin Time

Anesthetic Management Using Epidural Analgesia for Emergency Laparoscopic Cholecystectomy in a Patient with Lupus Anticoagulant Positivity and Prolonged Activated Partial Thromboplastin Time

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

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