[Coagulation Management During Open Heart Surgery Based on a Heparin Dose Sensitivity Test for Antiphospholipid...

Area of Science:

• Cardiology
• Hematology

Background:

• Antiphospholipid syndrome (APS) presents significant challenges in anticoagulation management, particularly during cardiac surgery.
• Severe aortic regurgitation and congestive heart failure necessitated aortic valve replacement (AVR) in a 63-year-old woman with APS.

Observation:

• The patient had a history of thrombotic events (cerebellar infarction, deep vein thrombosis) and recurrent miscarriages, indicating a high thrombosis risk.
• All three major antiphospholipid antibodies were positive, underscoring the complexity of her condition.

Findings:

• A patient-specific heparin-activated clotting time (ACT) titration curve was generated.
• A target ACT of 650 seconds was determined for a heparin concentration of 3 U/ml during cardiopulmonary bypass.

Implications:

• This individualized anticoagulation strategy facilitated a safe and successful bioprosthetic AVR.
• Effective management of APS during complex cardiac surgery can lead to favorable patient outcomes and discharge without complications.