Management of anticoagulation during cardiopulmonary bypass in a patient with a circulating lupus anticoagulant

Ducart, Anne; Collard, Édith; Osselaer, Jean Claude; Broka, Serge M.; Eucher, Philippe; Joucken, Kurt

doi:10.1016/s1053-0770(97)90125-7

Cited by 33 publications

(21 citation statements)

References 3 publications

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“…Other available options are (1) to use extra heparin to double the baseline ACT, (2) use of bivalirudin as an anticoagulant, (3) achieving a heparin concentration of >3 units/ml in blood, (4) plotting heparin/ACT titration curves, or (5) administration of less protamine, e.g., by giving half of the calculated dose or no protamine at all. [9] If the facility for measurement of heparin concentration is not available, more heparin than routine should be administered to prolong the baseline ACT. Celite ACT is recommended for monitoring of anticoagulation, because kaolin ACT is affected by antiphospholipid antibodies.…”

Section: Discussionmentioning

confidence: 99%

Aortic valve replacement in a patient with systemic lupus erythematosus

Kansara

Singh

Karlekar

et al. 2013

J Anaesthesiol Clin Pharmacol

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Valvular heart disease in systemic lupus erythematosus (SLE) is associated with substantial morbidity and mortality. Current therapy includes symptomatic measures and valve replacement. SLE can present major challenges because of accrued organ damage, coagulation defects and complex management regimes. The peri-operative goals are to maintain strict asepsis, avoid use of nephrotoxic drugs and thereby renal insult, and to promote early ambulation post-operatively.

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Section: Discussionmentioning

confidence: 99%

Aortic valve replacement in a patient with systemic lupus erythematosus

Kansara

Singh

Karlekar

et al. 2013

J Anaesthesiol Clin Pharmacol

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“…Individual case reports of cardiac surgical patients frequently describe thrombotic or haemorrhagic complications including early graft occlusion [93] haemothorax [94], pulmonary emboli, and limb ischaemia [95,96]. More optimistically, the literature includes several case reports of uneventful cardiac surgery [97,98]. A meta analysis of heart valve surgery by Gorki et al [2] demonstrated that the mortality is high with 7% early deaths and 12% late deaths after a mean follow-up period of less then 3 years.…”

Section: Outcomes Of Cardiac Surgery In Apls Patientsmentioning

confidence: 99%

Antiphospholipid syndrome; its implication in cardiovascular diseases: a review

Koniari

Siminelakis

Baikoussis

et al. 2010

J Cardiothorac Surg

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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.

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“…(e) Application of less protamine, e.g. by giving half of the calculated dose or no protamine at all [95,98,99,113,126].…”

Section: Intraoperative Management Of Coagulation -A Crucial Problem mentioning

confidence: 99%

The antiphospholipid syndrome and heart valve surgery

Gorki¹,

Malinovski²,

Stanbridge³

2008

European Journal of Cardio-Thoracic Surgery

125

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The antiphospholipid syndrome (APLS) is a complex autoimmune disease often connected to systemic lupus erythematodes. Main features are thromboses, fetal loss and specific antibodies. The involved autoantibodies are directed against plasma proteins such as beta2glycoprotein1 (beta2GPI) or prothrombin which depend on negatively charged phospholipids. Direct antibodies against phospholipids are of no importance for APLS. Clotting tests such as activated partial thromboplastin time or diluted Russell's viper venom test (dRVVT) can show a prolonged time for coagulation despite a prothrombotic state in vivo but the investigator needs awareness about disturbing phospholipid sources and other influential factors. Enzyme linked immuno sorbent assay tests for antibodies against cardiolipin, beta2GPI and prothrombin are valuable solid phase tests with different specificity. Antiphospholipid, anticardiolipin or lupus anticoagulant are misnomers in connection with APLS. They are preserved as a reminiscence of the pioneering work on the way to the still not exactly revealed basics of APLS. Valve operations in APLS patients seem to be rare; a meta-analysis of 57 cases proves that the perioperative management is, at the moment, an empirical approach with high morbidity and mortality in these young patients.

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Management of anticoagulation during cardiopulmonary bypass in a patient with a circulating lupus anticoagulant

Cited by 33 publications

References 3 publications

Aortic valve replacement in a patient with systemic lupus erythematosus

Aortic valve replacement in a patient with systemic lupus erythematosus

Antiphospholipid syndrome; its implication in cardiovascular diseases: a review

The antiphospholipid syndrome and heart valve surgery

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