[Anesthetic management for a patient with anti-phospholipid antigen syndrome]

A 54-year-old man with anti-phospholipid antigen syndrome (APS) was to undergo artifitial vascular replacement for arteriosclerotic obliterans. APS is characterized by the presense of anti-phospholipid antibodies, hypercoagulability, and prolonged phospholipid dependent coagulation such as activated clotting time (ACT). Perioperative thrombotic complications are frequent among patients with anti-phospholipid antigen syndrome. In these cases, perioperative heparin titration for anticoagulation monitoring is very important. In this patient, preoperative coagulation testing revealed prolonged partial thromboplastin time (APTT) and antithrombin-III (AT-III). In the operating room, a base line ACT was 124 sec. We decided to administer a standard protocol heparine dose of 100 IU x kg(-1) of body weight. After the artifitial vascular replacement, the ACT was recorded at 249 sec. Therefore, a 75 mg dose of protamine was administered. In this particular case, it is difficult to decided to administer the heparin dose. When an adequate platelet count, normal bleeding time, normal TT, and normal AT-III level are shown, it would be decided to use the heparin monitoring systems; ACT, circulating heparin concentrations, according to some reports. In this case, with standard protocol heparin, he had no complications in the postoperative days. The perioperative management was succeseful.