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Michael S, Sofia MG, Wei W, Patrick G, John A, Dana A. Efficacy of the Hepcon system in reducing hemorrhagic and thrombotic complications in antiphospholipid syndrome patients undergoing cardiac surgery. Perfusion 2023:2676591231197990. [PMID: 37608561 DOI: 10.1177/02676591231197990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Patients with Antiphospholipid Syndrome (APS) undergoing cardiopulmonary bypass (CPB) surgery are at increased risk for thrombotic and hemorrhagic complications. Anticoagulation during CPB is typically monitored with activated clotting time (ACT) which may be falsely prolonged in patients with APS. The Hepcon Hemostasis Management System quantitatively determines the whole blood heparin concentration through heparin/protamine titration. METHODS This was a retrospective study of APS patients who underwent cardiac surgery requiring CPB at the Cleveland Clinic between April 2013, and July 2020. The primary endpoint was the composite rate of hemorrhagic or thromboembolic complications per surgical case in patients monitored by Hepcon versus patients monitored by ACT. Secondary endpoints were median volume of chest tube output and packed red blood cell (PRBC) transfusion within the first three post-operative days. RESULTS 43 patients were included. 20 (47%) patients were monitored using Hepcon while 23 (53%) were monitored using ACT. For the primary endpoint of rate of thromboembolic or hemorrhagic complications per surgical case, there was no statistically significant difference between the Hepcon and ACT groups (HMS, 6/20 [30%]; ACT, 7/23 [30%]; p = >0.99). For the secondary endpoints, there was no statistically significant difference in median post-operative chest tube output (780 mL vs. 850 mL; p = 0.88) and median post-operative PRBC transfusion (1 unit vs. 0 unit; p = 0.28) between the Hepcon and ACT groups, respectively. CONCLUSION There was no difference in the composite outcome of thrombotic or hemorrhagic complications in patients monitored by Hepcon versus those monitored by ACT.
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Affiliation(s)
- Sheu Michael
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Molina Garcia Sofia
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Wei Wei
- Department of Biostatistics, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Grady Patrick
- Department of Perfusion, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Apostolakis John
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Angelini Dana
- Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, OH, USA
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2
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Simon ER, Rakholia M, McHenry ML, Mishra PK, Singh R, Javangula K, Minhaj MM, Chaney MA. Cardiac Surgery in a Patient With Antiphospholipid Syndrome and Heparin-Induced Thrombocytopenia. J Cardiothorac Vasc Anesth 2021; 36:1196-1206. [PMID: 34344598 DOI: 10.1053/j.jvca.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Eric R Simon
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Milap Rakholia
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA
| | - Marie LaPenta McHenry
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA
| | - Pankaj Kumar Mishra
- Department of Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom
| | - Rajendra Singh
- Cardiac Anaesthesia and Critical Care, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom
| | - Kalyana Javangula
- Department of Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom
| | - Mohammed M Minhaj
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL.
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3
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Abdelmahmuod EA, Hamad A, Almaghraby A, Mohamed S, Alkuwari M. Development of intracardiac thrombus in a young patient with antiphospholipid syndrome while she was on rivaroxaban: Case report and literature review. Clin Case Rep 2021; 9:e04137. [PMID: 34026171 PMCID: PMC8133078 DOI: 10.1002/ccr3.4137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/24/2021] [Indexed: 11/27/2022] Open
Abstract
The probability of right heart thrombus co-existence should be considered in patients with antiphospholipid syndrome (APS) who have pulmonary and cardiac symptoms. The prevention and management of intracardiac thrombotic events include early use of anticoagulation therapy.
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Affiliation(s)
| | | | - Ahmed Almaghraby
- Department of Cardiology Noninvasive LabsHeart HospitalHamad Medical CorporationDohaQatar
| | - Samah Mohamed
- Department of Cardiology Clinical ImagingHamad Medical CorporationDohaQatar
| | - Maryam Alkuwari
- Department of Cardiology Cardiac ImagingHamad Medical CorporationDohaQatar
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Parody-Cuerda G, García de la Borbolla-Fernández M, Jiménez-del Valle JR, González-Fernández FJ, Hidalgo-Urbano R, Barquero-Aroca JM. Trombosis obstructiva de prótesis mecánica mitral en paciente con síndrome antifosfolípido. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kolitz T, Shiber S, Sharabi I, Winder A, Zandman-Goddard G. Cardiac Manifestations of Antiphospholipid Syndrome With Focus on Its Primary Form. Front Immunol 2019; 10:941. [PMID: 31134062 PMCID: PMC6522847 DOI: 10.3389/fimmu.2019.00941] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/11/2019] [Indexed: 01/09/2023] Open
Abstract
Antiphospholipid syndrome (APS) is a multisystem autoimmune disease most commonly associated with recurrent arterial and venous thromboembolism and recurrent fetal loss. Other possible antiphospholipid antibody (aPL)-related clinical manifestations include cardiac involvement. The heart can be involved through immune mediated and /or thrombotic mechanisms. Mortality due to cardiovascular problems is elevated in APS. However, the cardiovascular risk in patients with primary APS (PAPS) compared with lupus-related APS is yet to be established. Cardiac symptoms of APS include valve abnormalities (thickening and vegetations), coronary artery disease (CAD), myocardial dysfunction, pulmonary hypertension, and intracardiac thrombi. Heart valve lesions are the most common cardiac manifestation, observed in approximately one third of PAPS patients and usually do not cause hemodynamic significance. Deposits of immunoglobulins including anticardiolipin (aCL), and of complement components, are commonly observed in affected heart valves from these patients. This suggests that an inflammatory process is initiated by aPL deposition, eventually resulting in the formation of valvular lesion. aPL may have a direct role in the atherosclerotic process via induction of endothelial activation. Multiple traditional and autoimmune-inflammatory risk factors are involved in triggering an expedited atherosclerotic arterial disease evident in APS. It is imperative to increase the efforts in early diagnosis, control of risk factors and close follow-up, in the attempt to minimize cardiovascular risk in APS. Clinicians should bear in mind that a multidisciplinary therapeutic approach is of paramount importance in these patients. This article reviews the cardiac detriments of APS, including treatment recommendations for each cardiac complication.
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Affiliation(s)
- Tamara Kolitz
- Department of Medicine C, Wolfson Medical Center, Holon, Israel
| | - Shachaf Shiber
- Department of Rheumatology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Sharabi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Wolfson Medical Center, Holon, Israel
| | - Asher Winder
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology, Wolfson Medical Center, Holon, Israel
| | - Gisele Zandman-Goddard
- Department of Medicine C, Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rachwan RJ, Daher GE, Fares J, Rachoin R. Complete Resolution of a Large Bicuspid Aortic Valve Thrombus with Anticoagulation in Primary Antiphospholipid Syndrome. Front Cardiovasc Med 2017; 4:59. [PMID: 28979899 PMCID: PMC5611389 DOI: 10.3389/fcvm.2017.00059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/05/2017] [Indexed: 01/08/2023] Open
Abstract
Native aortic valve thrombosis in primary antiphospholipid syndrome (APLS) is a rare entity. We describe a 38-year-old man who presented with neurological symptoms and a cardiac murmur. Transthoracic echocardiography detected a large bicuspid aortic valve thrombus. Laboratory evaluation showed the presence of antiphospholipid antibodies. Anticoagulation was started, and serial echocardiographic studies showed complete resolution of the aortic valve vegetation after 4 months. The patient improved clinically and had no residual symptoms. This report and review of the literature suggests that vegetations in APLS can be treated successfully with conservative treatment, regardless of their size.
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Affiliation(s)
- Rayan Jo Rachwan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ghassan E. Daher
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Jawad Fares
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rachoin Rachoin
- Division of Cardiovascular Medicine, Notre Dame des Secours University Hospital, Byblos, Lebanon
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7
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Sunjaya DB, Koster MJ, Osborn TG. 61-Year-Old Woman With Systemic Lupus Erythematosus and Chest Pain. Mayo Clin Proc 2017; 92:153-158. [PMID: 27842704 DOI: 10.1016/j.mayocp.2016.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/05/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Dharma B Sunjaya
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Matthew J Koster
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Thomas G Osborn
- Advisor to residents and Consultant in Rheumatology, Mayo Clinic, Rochester, MN.
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González-Moreno J, Callejas-Rubio JL, Ríos-Fernández R, Ortego-Centeno N. Antiphospholipid syndrome, antiphospholipid antibodies and solid organ transplantation. Lupus 2015; 24:1356-63. [DOI: 10.1177/0961203315595129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 06/17/2015] [Indexed: 11/16/2022]
Abstract
Antiphospholipid syndrome is considered a high risk factor for any kind of surgery. Considering that all solid organ transplants are critically dependent on the patency of vascular anastomosis, there is much concern about the consequences this pro-thrombotic condition may have on transplantation. Relatively little information is available in the literature assessing the real risk that antiphospholipid syndrome or the presence of antiphospholipid antibodies represent in solid organ transplantation. The aim of this article is to review the literature related to transplantation of solid organs in patients diagnosed with antiphospholipid syndrome or patients with positive antiphospholipid antibodies.
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Affiliation(s)
- J González-Moreno
- Internal Medicine Department, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain
| | - J L Callejas-Rubio
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Granada, Spain
| | - R Ríos-Fernández
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Granada, Spain
| | - N Ortego-Centeno
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Granada, Spain
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9
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Antiphospholipid syndrome and the heart: A case series and literature review. Autoimmun Rev 2015; 14:214-22. [DOI: 10.1016/j.autrev.2014.11.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/07/2014] [Indexed: 12/20/2022]
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Kim M, Kim SH, Moon SY, Jeong EG, Jung EH, Nam HS, Choi JH, Park K. Native aortic valve thrombosis resembling papillary fibroelastoma. J Cardiovasc Ultrasound 2014; 22:148-50. [PMID: 25309693 PMCID: PMC4192414 DOI: 10.4250/jcu.2014.22.3.148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/17/2014] [Accepted: 08/20/2014] [Indexed: 11/22/2022] Open
Abstract
The differential diagnosis of cardiac mass is important in determining the therapeutic plan and avoiding unnecessary surgical intervention. Non-invasive imaging methods would be useful in the diagnosis of suspected cardiac mass, because they may provide earlier diagnosis and more accurate assessment of cardiac mass. Native aortic valve thrombosis is a rare disorder and difficult to differentiate from a tumor, and in particular, a papillary fibroelastoma. Thus, the clinical decision making with imaging modalities should be performed cautiously. We recently met a female patient who had a aortic valve mass resembling papillary fibroelastoma in normal native valve. The patient underwent a surgical resection and the pathologic finding showed an organized thrombus with no evidence of papillary fibroelastoma.
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Affiliation(s)
- Minkwan Kim
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Suk-Hyun Kim
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Sang Yi Moon
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Eu Gene Jeong
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Eui Han Jung
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Hwa Seong Nam
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Jae-Hyuk Choi
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Kyungil Park
- Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea. ; Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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Amaya-Amaya J, Montoya-Sánchez L, Rojas-Villarraga A. Cardiovascular involvement in autoimmune diseases. BIOMED RESEARCH INTERNATIONAL 2014; 2014:367359. [PMID: 25177690 PMCID: PMC4142566 DOI: 10.1155/2014/367359] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/01/2014] [Indexed: 12/15/2022]
Abstract
Autoimmune diseases (AD) represent a broad spectrum of chronic conditions that may afflict specific target organs or multiple systems with a significant burden on quality of life. These conditions have common mechanisms including genetic and epigenetics factors, gender disparity, environmental triggers, pathophysiological abnormalities, and certain subphenotypes. Atherosclerosis (AT) was once considered to be a degenerative disease that was an inevitable consequence of aging. However, research in the last three decades has shown that AT is not degenerative or inevitable. It is an autoimmune-inflammatory disease associated with infectious and inflammatory factors characterized by lipoprotein metabolism alteration that leads to immune system activation with the consequent proliferation of smooth muscle cells, narrowing arteries, and atheroma formation. Both humoral and cellular immune mechanisms have been proposed to participate in the onset and progression of AT. Several risk factors, known as classic risk factors, have been described. Interestingly, the excessive cardiovascular events observed in patients with ADs are not fully explained by these factors. Several novel risk factors contribute to the development of premature vascular damage. In this review, we discuss our current understanding of how traditional and nontraditional risk factors contribute to pathogenesis of CVD in AD.
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Affiliation(s)
- Jenny Amaya-Amaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
| | - Laura Montoya-Sánchez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
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Martínez F, Furió E, Fabiá MJ, Pérez AV, González-Albert V, Rojo-Martínez G, Martínez-Larrad MT, Mena-Martín FJ, Soriguer F, Serrano-Ríos M, Chaves FJ, Martín-Escudero JC, Redón J, García-Fuster MJ. Risk factors associated with retinal vein occlusion. Int J Clin Pract 2014; 68:871-81. [PMID: 24548738 DOI: 10.1111/ijcp.12390] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS Retinal vein occlusion (RVO) is the most frequent retinal vascular disease after diabetic retinopathy in which arterial risk factors are much more relevant than venous factors. The objective was to evaluate the role of risk factors in the development of the first episode of RVO. SUBJECTS AND METHODS One hundred patients with RVO [mean age 56 years, 42% females and mean body mass index (BMI) 27.5 kg/m(2)] were recruited consecutively from the outpatient clinic of a tertiary hospital in Valencia (Spain). All subjects underwent clinical assessment including anthropometric and blood pressure measurements and laboratory test including homocysteine, antiphospholipid antibodies (aPLAs) and thrombophilia studies. In half of the subjects, a carotid ultrasonography was performed. Three control populations matched by age, sex and BMI from different population-based studies were used to compare the levels and prevalence of arterial risk factors. One cohort of young patients with venous thromboembolic disease was used to compare the venous risk factors. RESULTS Blood pressure levels and the prevalence of hypertension were significantly higher in the RVO population when compared with those for the general populations. There was also a large proportion of undiagnosed hypertension within the RVO group. Moreover, carotid evaluation revealed that a large proportion of patients with RVO had evidence of subclinical organ damage. In addition, homocysteine levels and prevalence of aPLAs were similar to the results obtained in our cohort of venous thromboembolic disease. CONCLUSIONS The results indicate that hypertension is the key factor in the development of RVO, and that RVO can be the first manifestation of an undiagnosed hypertension. Furthermore, the majority of these patients had evidence of atherosclerotic disease. Among the venous factors, a thrombophilia study does not seem to be useful and only the prevalence of hyperhomocysteinaemia and aPLAs is higher than in the general population.
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Affiliation(s)
- F Martínez
- Internal Medicine Department, Fundación de Investigación del Hospital Clínico de Valencia- INCLIVA, Hospital Clínico Universitario, Universidad de Valencia, Valencia, Spain; "Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología, Obesidad y Nutrición (CIBEROB)", Institute of Health Carlos III, Minister of Health, Madrid, Spain
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Moustafa S, Patton DJ, Balon Y, Kidd WT, Alvarez N. Mitral Valve Surgery for Marantic Endocarditis and Multiple Cerebral Embolisation. Heart Lung Circ 2013; 22:545-7. [DOI: 10.1016/j.hlc.2012.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 11/02/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
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Geri G, Cacoub P. Atteinte cardiaque au cours du syndrome des antiphospholipides. Presse Med 2011; 40:758-64. [DOI: 10.1016/j.lpm.2011.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 02/24/2011] [Indexed: 10/18/2022] Open
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17
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The heart in rheumatic disease. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00034-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Koniari I, Siminelakis SN, Baikoussis NG, Papadopoulos G, Goudevenos J, Apostolakis E. Antiphospholipid syndrome; its implication in cardiovascular diseases: a review. J Cardiothorac Surg 2010; 5:101. [PMID: 21047408 PMCID: PMC2987921 DOI: 10.1186/1749-8090-5-101] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 11/03/2010] [Indexed: 11/19/2022] Open
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.
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Affiliation(s)
- Ioanna Koniari
- Cardiothoracic Surgery Department, University of Patras, School of Medicine, Patras, Greece.
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Hernández V, Saavedra J, García Aguado C, Perea Egido J. Ischemic Left Ventricular Systolic Dysfunction as First Manifestation of Primary Antiphospholipid Syndrome in a Young Patient. Clin Cardiol 2010; 33:E54-6. [DOI: 10.1002/clc.20349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
The antiphospholipid syndrome (APS) is an autoimmune systemic disease that is diagnosed when there is vascular thrombosis and/or pregnancy morbidity occurring with persistently positive antiphospholipid antibodies (aPL) (lupus anticoagulant test, anticardiolipin antibodies, and/or anti-beta(2)-glycoprotein I antibodies). Although International APS Classification Criteria have been formulated to provide a uniform approach to APS research, aPL may cause a spectrum of clinical manifestations, some of which are not included in these criteria. The main aPL-related cardiac manifestations include valve abnormalities (vegetations and/or thickening), myocardial infarction (MI), intracardiac thrombi, and myocardial microthrombosis. In this article, we will review the definition, etiopathogenesis, clinical manifestations, diagnosis, and treatment of aPL-related clinical events with emphasis on cardiac manifestations.
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Affiliation(s)
- Diane George
- Department of Rheumatology, Yale School of Medicine, New Haven, CT 06520, USA.
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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. [PMID: 18922433 DOI: 10.1053/j.jvca.2008.01.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Indexed: 11/11/2022]
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