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Journal of Cardiothoracic Surgery

, 5:101

First Online: 03 November 2010Received: 17 February 2010Accepted: 03 November 2010


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.

Abbreviation listACSacute coronary syndromes

ACTactivated clotting time

aCLanticardiolipin antibodies

aPLantiphospholipid antibodies

APLSantiphospholipid syndrome


CPBcardiopulmonary bypass

cAPLScatastrophic APLS

CABGcoronary artery bypass grafting

DHCAdeep hypothermic circulatory arrest

dRVVTdiluted Russell-s viper venom test

DICdisseminated intravascular coagulation

HITheparin-induced thrombocytopenia

INRinternational normalized ratio

ICAM-1intracellular adhesion-molecule-1

Lpalipoprotein a

LMWHlow-molecular-weight heparin

LALupus anticoagulant

MImyocardial infarction

aPTTpartial thromboplastin time

PCIpercutaneous coronary interventions



PTprothrombin time

SIRSsystemic inflammatory response syndrome

SLEsystemic lupus erythematosus

TTPthrombotic thrombocytopenic purpura


t-PAtissue type plasminogen activator


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Author: Ioanna Koniari - Stavros N. Siminelakis - Nikolaos G. Baikoussis - Georgios Papadopoulos - John Goudevenos - Efstratios Ap


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