Heparin protocols in cardiovascular surgery for antiphospholipid syndrome: a clinical case report

Antiphospholipid syndrome (APS) is a prothrombotic disorder that presents significant challenges during cardiovascular surgery due to its high risk of both thrombotic and hemorrhagic complications. Perioperative management of anticoagulation, particularly with heparin, requires careful balancing to prevent catastrophic outcomes such as thromboembolism or excessive bleeding.

The patient was a 66-year-old man. Two years prior, he was diagnosed with deep vein thrombosis (DVT), and direct oral anticoagulant (DOAC) therapy was initiated. Further evaluation in the cardiology department revealed elevated anticardiolipin antibody levels, leading to a diagnosis of APS. While on DOAC therapy, he was found to have severe aortic valve stenosis caused by a bicuspid aortic valve and 45-mm dilation of the ascending aorta. Surgical intervention was deemed necessary, and the operation was performed. As activated clotting time (ACT) tends to be elevated in APS, intraoperative heparin concentration was closely monitored. The surgery proceeded without perioperative embolic events, and the patient had an uneventful postoperative course.

We report a case of open-heart surgery in a patient with APS, where perioperative embolic events were successfully avoided through close monitoring of blood heparin concentrations.