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Perioperative Management of Anticoagulation in the Patient with the Antiphospholipid Syndrome in Cardiac Surgery and Cardiac Interventions

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Perioperative Management of Patients with Rheumatic Disease

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Abstract

The antiphospholipid syndrome (APS) is considered the most common acquired hypercoagulable disorder associated with thrombosis. It is an antibody-mediated prothrombotic state characterized by venous and/or arterial thrombosis or obstetrical morbidity in conjunction with laboratory identification of antiphospholipid antibodies (aPL). These antibodies, recently referred to as the “antiphospholipid triangle,” include anticardiolipin antibodies (aCL), anti-β2-glycoprotein I antibodies (aβ2GPI), and the lupus anticoagulant (LA) [1]. Antiphospholipid antibodies identified in otherwise healthy individuals after a venous or arterial thrombotic or obstetrical event is referred to as primary APS. Secondary APS is the term used when APS coexists with an underlying systemic autoimmune disease such as systemic lupus erythematosus (SLE). Antibodies also occur in asymptomatic individuals with no history of thrombosis. They can also be detected in persons on medications particularly important to the cardiac patient including procainamide, hydralazine, quinidine, and the angiotensin-converting enzyme (ACE) inhibitors [2].

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References

  1. Galli M. The antiphospholipid triangle. J Thromb Haemost. 2009;8:234–6.

    PubMed  Google Scholar 

  2. Park KW. The antiphospholipid syndrome. Int Anesthesiol Clin. 2004;42:45–57.

    Article  PubMed  Google Scholar 

  3. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome. J Thromb Haemost. 2006;4:295–306.

    Article  PubMed  CAS  Google Scholar 

  4. Cartwright BL, Bean M, Cooper JO. Lupus anticoagulant, antiphospholipid syndrome and cardiac surgery. Anaesth Intensive Care. 2010;38:364–9.

    PubMed  CAS  Google Scholar 

  5. Gurlek A, Pamir G, Ozdol C, et al. Association between anticardiolipin antibodies and recurrent cardiac events in patients with acute coronary syndrome. Int Heart J. 2005;46:631–8.

    Article  PubMed  CAS  Google Scholar 

  6. Turiel M, Sarzi-Puttini P, Peretti R, et al. Five-year follow up by transesophageal echocardiographic studies in primary antiphospholipid syndrome. Am J Cardiol. 2005;96:574–9.

    Article  PubMed  Google Scholar 

  7. Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med. 2002;346:752–63.

    Article  PubMed  CAS  Google Scholar 

  8. Colli A, Mestres CA, Espinosa G, et al. Heart valve surgery in patients with the antiphospholipid syndrome; analysis of a series of nine cases. Eur J Cardiothorac Surg. 2010;37:154–8.

    Article  PubMed  Google Scholar 

  9. Cervera R, Khamsata MA, Font J, et al. High prevalence of significant heart valve lesions in patients with the primary antiphospholipid syndrome. Lupus. 1991;1:43–7.

    Article  PubMed  CAS  Google Scholar 

  10. Christodoulou C, Sangle S, D’Cruz DP. Vasculopathy and arterial stenotic lesions in the antiphospholipid syndrome. Rheumatology. 2007;46:907–10.

    Article  PubMed  CAS  Google Scholar 

  11. Grzybczak R, Undas A, Rostoff P, et al. Life-threatening cardiac manifestations of primary antiphospholipid syndrome. Heart Vessels. 2010;25:267–9.

    Article  PubMed  Google Scholar 

  12. Roldan C. A valvular and coronary heart disease in systemic inflammatory diseases. Heart. 2008;94:1089–101.

    Article  PubMed  Google Scholar 

  13. Silbiger JJ. The cardiac manifestations of antiphospholipid syndrome and their echocardiographic recognition. J Am Soc Echocardiogr. 2009;22:1100–8.

    Article  PubMed  Google Scholar 

  14. George D, Erkan D. Antiphospholipid syndrome. Prog Cardiovasc Dis. 2009;52:115–25.

    Article  PubMed  CAS  Google Scholar 

  15. East CJ, Clements F, Matthew J, Slaughter T. Antiphospholipid syndrome and cardiac surgery: management of anticoagulation in two patients. Anesth Analg. 2000;90:1098–101.

    Article  PubMed  CAS  Google Scholar 

  16. Hamsten A, Norberg R, Bjorkholm M, et al. Antibodies to cardiolipin in young survivors of myocardial infarction: an association with recurrent cardiovascular events. Lancet. 1986;1(8473):113–5.

    Article  PubMed  CAS  Google Scholar 

  17. Cervera R, Piette JC, Font J, et al. Antiphospholipid syndrome. Arthritis Rheum. 2002;46:1019–27.

    Article  PubMed  Google Scholar 

  18. Tenedios F, Erkan D, Lockshin MD. Cardiac manifestations in the antiphospholipid syndrome. Rheum Dis Clin North Am. 2006;32:491–507.

    Article  PubMed  Google Scholar 

  19. Long BR, Leya F. The role of antiphospholipid syndrome in cardiovascular disease. Hematol Oncol Clin North Am. 2008;22:79–94.

    Article  PubMed  Google Scholar 

  20. Shi W, Krillis SA, Chong BH, et al. Prevalence of lupus anticoagulant and anticardiolipin antibodies in a healthy population. Aust N Z J Med. 1990;20:231–6.

    Article  PubMed  CAS  Google Scholar 

  21. Vila P, Hernandez MC, Lopez-Fernandez MF. Prevalence, follow up and clinical significance of the anticardiolipin antibodies in normal subjects. Thromb Haemost. 1994;72:209–13.

    PubMed  CAS  Google Scholar 

  22. Lim W, Crowther MA, Eikelboom JW. Management of antiphospholipid antibody syndrome. JAMA. 2006;295:1050–7.

    Article  PubMed  CAS  Google Scholar 

  23. Jervis K, Senthilnathan V, Lerner AB. Management of a patient with lupus anticoagulant and antiphospholipid syndrome for off-pump coronary artery bypass grafting using the Hepcon® system. Anesth Analg. 2009;108:1116–9.

    Article  PubMed  Google Scholar 

  24. Hegde VAP, Vivas Y, Shah H, Haybron D, Srinivasan V, Dua A, Gradman A. Cardiovascular surgical outcomes in patients with the antiphospholipid syndrome – a case series. Heart Lung Circ. 2007;16:423–7.

    Article  PubMed  Google Scholar 

  25. Long AA, Ginsberg JS, Brill-Edwards P, et al. The relationship of antiphospholipid antibodies to thromboembolic disease in systemic lupus erythematosus: a cross-sectional study. Thromb Haemost. 1991;66:520–4.

    PubMed  CAS  Google Scholar 

  26. Bruce IN, Clark-Soloninka CA, Spitzer KA, et al. Prevalence of antibodies in beta2-glycoprotein I in systemic lupus erythematosus and their association with antiphospholipid antibody syndrome criteria: a single center study and literature review. J Rheumatol. 2000;27:2833–7.

    PubMed  CAS  Google Scholar 

  27. Gorki H, Malinovski V, Stanbridge RDL. The antiphospholipid syndrome and heart valve surgery. Eur J Cardiothorac Surg. 2008;33:168–81.

    Article  PubMed  Google Scholar 

  28. Hojnik M, George J, Ziporen L, et al. Heart valve involvement (Libman-Sacks endocarditis in the antiphospholipid syndrome). Circulation. 1996;93: 1579–87.

    Article  PubMed  CAS  Google Scholar 

  29. Nesher G, Ilany J, Rosenmann D, et al. Valvular dysfunction in antiphospholipid syndrome: prevalence, clinical features and treatment. Semin Arthritis Rheum. 1997;27:27–35.

    Article  PubMed  CAS  Google Scholar 

  30. Galve E, Ordi J, Barquinero J, et al. Valvular heart disease in primary antiphospholipid syndrome. Ann Intern Med. 1992;16:293–8.

    Google Scholar 

  31. Roman MJ, Salmon JE, Sobel R, et al. Prevalence and relation to risk factors of carotid atherosclerosis and left ventricular hypertrophy in systemic lupus erythematosus and antiphospholipid syndrome. Am J Cardiol. 2001;87:663–6.

    Article  PubMed  CAS  Google Scholar 

  32. Zuckerman E, Toubi E, Shiran A, et al. Anticardiolipin antibodies and acute myocardial infarction in non-systemic lupus erythematosus patients: a controlled prospective study. Am J Med. 1996;101:381–6.

    Article  PubMed  CAS  Google Scholar 

  33. Vaarala O, Manttari M, Manninen V, et al. Anticardiolipin antibodies and risk of myocardial infarction in a prospective cohort of middle-aged men. Circulation. 1995;91:23–7.

    Article  PubMed  CAS  Google Scholar 

  34. Farsi A, Domeneghetti MP, Fedi S, et al. High prevalence of anti-ß2 glycoprotein I antibodies in patients with ischemic heart disease. Autoimmunity. 1999;30:93–8.

    Article  PubMed  CAS  Google Scholar 

  35. Brey RL, Abbott RD, Curb JD, et al. Beta-2-glycoprotein 1-dependent anticardiolipin antibodies and risk of ischemic stroke and myocardial infarction: the Honolulu heart program. Stroke. 2001;32:1701–6.

    Article  PubMed  CAS  Google Scholar 

  36. Bick RL, Arun B, Frenkel EP. Antiphospholipid thrombosis syndromes. Haemostasis. 1999;29:100–10.

    PubMed  CAS  Google Scholar 

  37. Erdogan D, Goren MT, Diz-Kuckkaya R, et al. Assessment of cardiac structure and left atrial appendage functions in primary antiphospholipid syndrome: a transesophageal echocardiographic study. Stroke. 2005;36:592–6.

    Article  PubMed  Google Scholar 

  38. Turiel M, Muzzupappa S, Gottardi B. Evaluation of cardiac abnormalities and embolic sources in primary antiphospholipid syndrome by transesophageal echocardiography. Lupus. 2000;9:406–12.

    Article  PubMed  CAS  Google Scholar 

  39. Berkun Y, Elami A, Meir K, et al. Increased morbidity and mortality in patients with antiphospholipid syndrome undergoing valve replacement surgery. J Thorac Cardiovasc Surg. 2004;127:414–20.

    Article  PubMed  Google Scholar 

  40. Ciocca RG, Choi J, Graham AM. Antiphospholipid antibodies lead to increased risk in cardiovascular surgery. Am J Surg. 1995;170:198–200.

    Article  PubMed  CAS  Google Scholar 

  41. Massoudy P, Cetin SM, Thielmann M, et al. Antiphospholipid syndrome in cardiac surgery – an underestimated coagulation disorder. Eur J Cardiothorac Surg. 2005;28:133–7.

    Article  PubMed  Google Scholar 

  42. Weiss S, Nyzio JB, Cines D, Detre J, Milas BL, Narula N, Floyd TF. Antiphospholipid syndrome: intraoperative and postoperative anticoagulation in cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22:735–9.

    Article  PubMed  Google Scholar 

  43. Morton KE, Gavaghan TP, Krilis SA, et al. Coronary artery bypass graft failure – an autoimmune phenomenon? Lancet. 1986;2:1353–7.

    Article  PubMed  CAS  Google Scholar 

  44. Ludia C, Domenico P, Monia C, et al. Antiphospholipid antibodies: a new risk factor for restenosis after percutaneous transluminal coronary angioplasty. Autoimmunity. 1998;27:141–8.

    Article  PubMed  CAS  Google Scholar 

  45. Chambers JD, Haire WD, Deligonul U. Multiple early percutaneous transluminal coronary angioplasty failures related to lupus anticoagulant. Am Heart J. 1996;132:189–90.

    Article  PubMed  Google Scholar 

  46. Su HM, Lee KT, Chu CH, et al. Acute thrombosis after elective direct intracoronary stenting in primary antiphospholipid syndrome: a case report. Kaohsiung J Med Sci. 2003;19:177–82.

    Article  PubMed  Google Scholar 

  47. Weissman A, Coplan NL. Antiphospholipid antibody syndrome and acute stent thrombosis. Rev Cardiovasc Med. 2006;7:244–6.

    PubMed  Google Scholar 

  48. Dunning J, Versteegh M, Fabbri A, et al. Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg. 2008;34:73–92.

    Article  PubMed  Google Scholar 

  49. van Ryn J, Stangier J, Haertter S, et al. Dabigatran etexilate- a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost. 2010;103:1116–27.

    Article  PubMed  Google Scholar 

  50. Boehringer Ingelheim. Pradaxa (dabigatran etexilate package insert). Ridgefield. 2010.

    Google Scholar 

  51. Bybee KA, Powell BD, Valeti U, et al. Preoperative aspirin therapy is associated with improved postoperative outcomes in patients undergoing coronary artery bypass grafting. Circulation. 2005;112:1286–92.

    Google Scholar 

  52. Mangano DT. Multicenter study of perioperative ischemia research: aspirin and mortality from coronary bypass surgery. N Engl J Med. 2002;347:1309–17.

    Article  PubMed  CAS  Google Scholar 

  53. Topol E. Aspirin with bypass surgery: from taboo to new standard of care. N Engl J Med. 2002;347:1359–60.

    Article  PubMed  Google Scholar 

  54. Alexander JH, Berger PB, Hafley G et al. Impact of early clopidogrel use on angiographic and clinical outcomes following coronary artery bypass surgery; findings from PREVENT IV. J Am Coll Cardiol. 2006;47(suppl A) (4):178A.

    Google Scholar 

  55. Mehta RH, Roe MT, Mulgund J, et al. Acute clopidogrel use and outcomes in patients with non-ST-segment elevation acute coronary syndromes undergoing coronary artery bypass surgery. J Am Coll Cardiol. 2006;48:281–6.

    Article  PubMed  CAS  Google Scholar 

  56. Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494–502.

    Article  PubMed  CAS  Google Scholar 

  57. Douketis JD, Johnson JA, Turpie AG. Low-molecular-weight-heparin as bridging anticoagulation during interruption of warfarin; assessment of a standardized periprocedural anticoagulation regimen. Arch Intern Med. 2004;164:1319–26.

    Article  PubMed  CAS  Google Scholar 

  58. Douketis JD, Berger PB, Dunn AS, et al. The perioperative management of antithrombotic therapy. The eighth ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2008;133(suppl):299S–339.

    Article  PubMed  CAS  Google Scholar 

  59. Landenhed M, Johansson M, Eringe D, et al. Fondaparinux or enoxaparin: a comparative study of postoperative bleeding in coronary artery bypass grafting surgery. Scand Cardiovasc J. 2010;44(2):100–6.

    Article  PubMed  CAS  Google Scholar 

  60. Selke FW, DiMaio JM, Caplan LR, et al. Comparing on-pump and off-pump coronary artery bypass grafting: numerous studies but few conclusions: a scientific statement from the American Heart Association Council on cardiovascular surgery and anesthesia in collaboration with the interdisciplinary working group on quality of care and outcomes research. Circulation. 2005;111:2858–64.

    Article  Google Scholar 

  61. Hirose H, Amano A, Takahashi A. Off-pump coronary artery bypass grafting for elderly patients. Ann Thorac Surg. 2001;72:2013–9.

    Article  PubMed  CAS  Google Scholar 

  62. Hoff SJ, Ball SK, Coltharp WH, et al. Coronary artery bypass in patients 80 years and over; is off-pump the operation of choice? Ann Thorac Surg. 2002; 74:S1340–3.

    Article  PubMed  Google Scholar 

  63. Sabik JF, Blackstone EH, Lytle BW, et al. Equivalent midterm outcomes after off-pump and on-pump coronary surgery. J Thorac Cardiovasc Surg. 2004;127:142–8.

    Article  PubMed  Google Scholar 

  64. Horimoto S, Horimoto H, Sawada Y, et al. Off-pump coronary artery bypass in a patient with the antiphosopholipid syndrome. J Cardiovasc Surg. 2005;46:81–3.

    CAS  Google Scholar 

  65. Maddali MM, Albahrani MJ. Lupus anticoagulant and off-pump coronary bypass; dilemma of anticoagulation. Asian Cardiovasc Thorac Ann. 2007;15:246–8.

    PubMed  Google Scholar 

  66. Casati V, Gerli C, Franco A, et al. Activation of coagulation and fibrinolysis during coronary surgery: on pump versus off-pump techniques. Anesthesiology. 2001;95:1103–9.

    Article  PubMed  CAS  Google Scholar 

  67. Tanaka KA, Thourani VH, Williams WH, et al. Heparin anticoagulation in patients undergoing off-pump and on-pump coronary bypass surgery. J Anesth. 2007;21:297–303.

    Article  PubMed  Google Scholar 

  68. Gillinov AM, Cosgrove DM. Current status of mitral valve repair. Am Heart Hosp J. 2003;1:47–54.

    Article  PubMed  Google Scholar 

  69. Bonow RO, Carabello BA, Chatterjee K, et al. Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Circulation. 2008;118:e523–660.

    Google Scholar 

  70. Bouma W, Klinkenberg TJ, van der Horst ICC, et al. Mitral valve surgery for mitral regurgitation caused by Libman-Sacks endocarditis: a report of four cases and a systematic review of the literature. J Cardiothorac Surg. 2010;5:1–13.

    Article  Google Scholar 

  71. Yun KI, Miller DC. Mitral valve repair versus replacement. Cardiol Clin. 1991;9:315–27.

    PubMed  CAS  Google Scholar 

  72. Horrow JC, Mueksch JN. Coagulation testing. In: Gravlee G, Davis RF, Stammers AH, et al., editors. Cardiopulmonary bypass: principles and practice. Philadelphia: Lippincott; 471. p. 459–71.

    Google Scholar 

  73. Myers GJ, Hirsch GM. Double valve replacement in a patient with anticardiolipin syndrome. Perfusion. 1999;14:397–401.

    PubMed  CAS  Google Scholar 

  74. Kato Y, Isobe F, Sasaki Y, et al. Secondary mitral valve replacement in antiphospholipid syndrome and chronic renal failure. Jpn J Thorac Cardiovasc Surg. 2001;49:728–31.

    Article  PubMed  CAS  Google Scholar 

  75. Fitzgerald DJ, Patel A, Body SC, et al. The relationship between heparin level and activated clotting time in the adult cardiac surgery. Perfusion. 2009;24:93–6.

    Article  PubMed  CAS  Google Scholar 

  76. Shuhaibar MN, Hargrove M, Millat MH, et al. How much heparin do we really need to go on pump? A rethink of current practices. Eur J Cardiothorac Surg. 2004;26:947–50.

    Article  PubMed  CAS  Google Scholar 

  77. Tanaka K, Takao M, Yada I, et al. Alteration in coagulation and fibrinolysis associated with cardiopulmonary bypass during open heart surgery. J Cardiothorac Anesth. 1989;3:181–8.

    Article  PubMed  CAS  Google Scholar 

  78. Weisinger AS, Levy JH. Current hematologic issues in cardiac surgery and cardiopulmonary bypass. Sem Cardiothorac Vasc Anesth. 1998;2:259–71.

    Article  Google Scholar 

  79. Olson Jd, Arkin CF, Brandt JT, et al. College of American Pathologists conference XXXI on laboratory monitoring of anticoagulant therapy. Arch Pathol Lab Med. 1998;122:782–98.

    PubMed  CAS  Google Scholar 

  80. Sheikh F, Lechiowicz A, Setlur R, Rauch A, Dunn H. Recognition and management of patients with antiphospholipid antibody syndrome undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 1997;11:764–6.

    Article  PubMed  CAS  Google Scholar 

  81. Brownstein L, Bartholomew TP, Silver DG, Berry CM. A case report of mitral valve replacement in a patient with lupus antibody syndrome. Perfusion. 2003;18:373–6.

    Article  PubMed  Google Scholar 

  82. Lango R, Pawlaczyk R, Raszeja-Specht A, Smolenski RT, Rogowski J, Rutkowski B, Szutowicz A. Aortic valve replacement and perioperative management in hemodialyzed patient with antiphospholipid syndrome. Int J Artif Organs. 2004;27:69–73.

    PubMed  CAS  Google Scholar 

  83. Ducart AR, Collard EL, Osselaer JC, et al. Management of anticoagulation during cardiopulmonary bypass in a patient with a circulating lupus anticoagulant. J Cardiothorac Vasc Anesth. 1997;11:878–9.

    Article  PubMed  CAS  Google Scholar 

  84. Lennon MJ, Thackray NM, Gibbs NM. Anti-factor Xa monitoring of anticoagulation during cardiopulmonary bypass in a patient with antiphospholipid syndrome. Anaesth Intensive Care. 2003;31:95–8.

    PubMed  CAS  Google Scholar 

  85. Goodman SG, Menon V, Cannon CP, et al. Acute ST-segment elevation myocardial infarction. American College of Chest Physicians evidence-based clinical practice guidelines (8th ed). Chest. 2008;133: 708S–75S

    Google Scholar 

  86. Smith SC, Feldman TE, Hirshfeld JW, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (ACC/AHA/SCAI writing committee to update the 2001 guidelines for percutaneous coronary intervention). Circulation. 2006;113:e166–286.

    Google Scholar 

  87. Badak O, Guneri S, Kirimli O, et al. Primary stenting in a patient with acute myocardial infarction and primary antiphospholipid syndrome. J Invasive Cardiol. 2002;14:194–7.

    PubMed  Google Scholar 

  88. Jankowski M, Dudek D, Dubiel JS, et al. Successful coronary stent implantation in a patient with primary antiphospholipid syndrome. Blood Coagul Fibrinolysis. 1998;9:753–6.

    Article  PubMed  CAS  Google Scholar 

  89. Musuraca G, Imperadore F, Terraneo C, et al. Successful treatment of post-exertion acute myocardial infarction by primary angioplasty and stenting in a patient with antiphospholipid antibody syndrome. Blood Coagul Fibrinolysis. 2004;15:95–8.

    Article  PubMed  Google Scholar 

  90. Takeuchi S, Obayashi T, Toyama J. Primary antiphospholipid syndrome with acute myocardial infarction recanalised by PTCA. Heart. 1998;79:96–8.

    PubMed  CAS  Google Scholar 

  91. Timurkaynak T, Cemri M, Ozdemir M, et al. Primary angioplasty and stenting in a patient with primary antiphospholipid syndrome and thrombocytopenia. J Invasive Cardiol. 2001;13:395–400.

    PubMed  CAS  Google Scholar 

  92. Umesan CV, Kapoor A, Nityanand S, et al. Recurrent acute coronary events in a patient with primary antiphospholipid syndrome; successful management with intracoronary stenting. Int J Cardiol. 1999;71:99–102.

    Article  PubMed  CAS  Google Scholar 

  93. Santrach PJ. Devices for monitoring heparin and protamine in the operating room. Sem Cardiothorac Vasc Anesth. 2003;7:379–85.

    Article  Google Scholar 

  94. Despotis GJ, Joist JH, Hogue Jr CW, et al. The impact of heparin concentration and activated clotting time monitoring on blood conservation. A prospective, randomized evaluation in patients undergoing cardiac operation. J Thorac Cardiovasc Surg. 1995;110:46–54.

    Article  PubMed  CAS  Google Scholar 

  95. Galli M, Ruggeri L, Barbui T. Differential effects of anti-beta2-glycoprotein I and antiprothrombin antibodies on the anticoagulant activity of activated protein C. Blood. 1998;91:1999–2004.

    PubMed  CAS  Google Scholar 

  96. Erkan D, Leibowitz E, Berman J, et al. Perioperative medical management of antiphospholipid syndrome; hospital for special surgery experience, review of literature, and recommendations. J Rheumatol. 2002;29: 843–9.

    PubMed  Google Scholar 

  97. Perry DJ, Fitzmaurice DA, Kitchen S, et al. Point of care testing in haemostasis. Br J Haematol. 2010;150:501–14.

    Article  PubMed  Google Scholar 

  98. Green JA, Spiess BD. Current status of antifibrinolytics in cardiopulmonary bypass and elective deep hypothermic circulatory arrest. Anesthesiol Clin North Am. 2003;21:527–51.

    Article  CAS  Google Scholar 

  99. Munoz JJ, Birkmeyer NJO, Birkmeyer JD, et al. Is (epsilon)-aminocaproic acid as effective as aprotinin in reducing bleeding with cardiac surgery? A meta-analysis. Circulation. 1999;99:81–9.

    Article  PubMed  CAS  Google Scholar 

  100. Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs. 1985;29:236–61.

    Article  PubMed  CAS  Google Scholar 

  101. Royston D. The serine antiprotease aprotinin (Trasylol): a novel approach to reducing post-operative bleeding. Blood Coagul Fibrin. 1990;1:55–69.

    Article  CAS  Google Scholar 

  102. Rand JH, Wu XX, Andree HA, et al. Antiphospholipid antibodies accelerate plasma coagulation by inhibiting annexin-V binding to phospholipids: a “lupus procoagulant” phenomenon. Blood. 1998;92:1652–60.

    Google Scholar 

  103. Henry D, Carless P, Fergusson D, et al. The safety of aprotinin and lysine-derive antifibrinolytic drugs in cardiac surgery: a meta analysis. CMAJ. 2009;180:183–93.

    Article  PubMed  Google Scholar 

  104. Aren C. Heparin and protamine during cardiac surgery. Perfusion. 1989;4:171–81.

    Article  Google Scholar 

  105. Teoh KKT, Young E, Blackall ME, et al. Can extra protamine eliminate heparin rebound following cardiopulmonary bypass surgery? J Thorac Cardiovasc Surg. 2004;12:211–9.

    Article  CAS  Google Scholar 

  106. Englberger L, Streich M, Tevaeari H, et al. Different anticoagulation strategies in off-pump coronary artery bypass operations: a European survey. Interact Cardiovasc Thorac Surg. 2008;7:378–82.

    Article  PubMed  Google Scholar 

  107. Andersen MN, Mendelow M, Alfano CA. Experimental studies of heparin-protamine activity with special reference to protamine inhibition of clotting. Surgery. 1959;46:1060–8.

    PubMed  CAS  Google Scholar 

  108. Dornan RIP. Acute postoperative biventricular failure associated with antiphospholipid antibody syndrome. Br J Anaesth. 2004;5:748–54.

    Article  Google Scholar 

  109. Mariani MA, Gu YJ, Boonstra PW, et al. Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate? Ann Thorac Surg. 1999;67:1370–5.

    Article  PubMed  CAS  Google Scholar 

  110. Dunn AS, Spyropoulous A, Turpie AG. Bridging therapy in patients on long term oral anticoagulation who require surgery: the Prospective Peri-operative Enoxaparin Cohort Trial (PROSPECT). J Thromb Haemost. 2007;5:2211–8.

    Article  PubMed  CAS  Google Scholar 

  111. Turpie AG, Douketis JD. Enoxaparin is effective and safe in bridging anticoagulation in patients with a mechanical prosthetic heart valve who require temporary interruption of warfarin because of surgery or an invasive procedure. Blood. 2004;104:202A.

    Google Scholar 

  112. Kovacs MJ, Kearon C, Rodger M, et al. Single-arm study of bridging therapy with low-molecular-weight heparin for patients at risk of arterial embolism who require temporary interruption of warfarin. Circulation. 2004;110:1658–63.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    John R. Bartholomew M.D., FACC

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Correspondence to John R. Bartholomew M.D., FACC .

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  1. Department of Rheumatologic, and Immunologic Disease, Cleveland Clinic, Euclid Avenue 9500, Cleveland, 44195, Ohio, USA

    Brian F. Mandell

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Bartholomew, J.R. (2013). Perioperative Management of Anticoagulation in the Patient with the Antiphospholipid Syndrome in Cardiac Surgery and Cardiac Interventions. In: Mandell, B. (eds) Perioperative Management of Patients with Rheumatic Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2203-7_9

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