Management of Anticoagulation and Antifibrinolytics in Catastrophic Antiphospholipid Syndrome

Document Type

Article

Publication Date

9-1-2024

Publication Title

Seminars in cardiothoracic and vascular anesthesia

Abstract

Antiphospholipid syndrome (APS) is an autoimmune disorder that presents with hypercoagulability and results in a lab artifact of prolonged PTT. The most severe form is catastrophic antiphospholipid antibody syndrome (CAPS), which manifests as rapidly progressing thromboses in multiple organ systems leading to multi-organ ischemia. The mainstay management CAPS is anticoagulation and systemic corticosteroids. Antifibrinolytic agents have previously been thought to be relatively contraindicated in CAPS due to the pro-thrombotic nature of the disease; the complex coagulation profile of CAPS can make it difficult to assess the risks and benefits of antifibrinolytic therapy. Also, should a patient with CAPS require cardiopulmonary bypass (CPB) for surgery, it poses a unique challenge in providing appropriate anticoagulation in the setting of prolonged ACT. We present a case of a 32-year-old postpartum female with CAPS requiring heart transplant who safely received intraoperative antifibrinolytic therapy and was successfully anticoagulated during CPB after perioperative plasmapheresis.

Medical Subject Headings

Humans; Antiphospholipid Syndrome; Female; Adult; Antifibrinolytic Agents; Anticoagulants; Cardiopulmonary Bypass; Plasmapheresis; Heart Transplantation

PubMed ID

38705843

ePublication

ePub ahead of print

Volume

28

Issue

3

First Page

181

Last Page

187

Find It @ Sladen

Share

COinS