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Intraoperative Heparin Dose Adjustment in Chronic Limb-Threatening Ischemia Associated with Antiphospholipid

Toru Kikuchi1,2, Yohei Yamamoto1, Natsuho Maekawa1

  • 1Division of Vascular Surgery, Department of Cardiovascular Surgery, Institute of Science Tokyo, Tokyo, Japan.

Annals of Vascular Diseases
|September 1, 2026
PubMed

Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disorder characterized by recurrent arterial and venous thrombosis, as well as pregnancy complications. Laboratory findings often show prolongation of activated partial thromboplastin time, which complicates monitoring during heparin therapy. We present the case of a 69-year-old woman with APS who developed chronic limb-threatening ischemia. She underwent successful bilateral lower-extremity open surgical revascularizations guided by a preoperatively obtained heparin-activated clotting time (ACT) titration curve to define individualized intraoperative anticoagulation targets. This method offered a straightforward and dependable strategy for personalized anticoagulation management and may enhance the safety of peripheral arterial revascularization in patients with APS.

Keywords:
activated clotting timeantiphospholipid syndromechronic limb-threatening ischemia

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