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Current Rheumatology Reports
Published in: Current Rheumatology Reports 7/2014

01-07-2014 | SURGERY AND PERIOPERATIVE CARE (CR MACKENZIE AND SM GOODMAN, SECTION EDITORS)

Perioperative Management of Antiphospholipid Antibody-Positive Patients

Authors: Katherine H. Saunders, Doruk Erkan, Michael D. Lockshin

Published in: Current Rheumatology Reports | Issue 7/2014

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Abstract

Perioperative management of antiphospholipid antibody (aPL)-positive patients is challenging because there are limited data on which to base recommendations. This population of patients is at high risk of thrombosis at the time of surgery; it is essential that medical and surgical teams devise a plan to minimize the patient’s risk of thrombosis without increasing bleeding risk. During the perioperative period, pharmacological methods should be combined with physical methods, patients should be closely observed for thrombosis, and any deviation from the normal course should be considered a potential aPL-related event. Periods without anticoagulation should be kept to an absolute minimum for aPL-positive patients with a history of thrombosis and physicians should keep in mind that thrombosis can occur despite optimum prophylaxis.
Literature
1.
Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295–306.PubMedCrossRef
2.••
Saunders KH, Erkan D. Perioperative management of antiphospholipid antibody positive patients during non-cardiac surgeries. In: Mandell BF, editor. Perioperative management of the patient with rheumatic disease. 1st ed. New York: Springer; 2012. p. 91–107. This book chapter is a review of the perioperative management of aPL-positive patients undergoing noncardiac surgery. It provides a detailed analysis of the literature and offers expert recommendations. It also includes information on the role of aspirin, hydroxychloroquine, and statins during the perioperative period.
3.
Asherson RA, Cervera R, de Groot PG, for the Catastrophic Antiphospholipid Syndrome Registry Project Group, et al. Catastrophic antiphospholipid syndrome: international consensus statement on classification criteria and treatment guidelines. Lupus. 2003;12:530–4.PubMedCrossRef
4.
5.
Vila P, Hernández MC, López-Fernández MF, Batlle J. Prevalence, follow-up and clinical significance of the anticardiolipin antibodies in normal subjects. Thromb Haemost. 1994;72:209–13.PubMed
6.
Erkan D, Lockshin M. New approaches for managing antiphospholipid syndrome. Nat Clin Pract Rheumatol. 2009;5:160–70.PubMedCrossRef
7.
Fischetti F, Durigutto P, Pellis V, et al. Thrombus formation induced by antibodies to beta2-glycoprotein I is complement dependent and requires a priming factor. Blood. 2005;106:2340–6.PubMedCrossRef
8.
Kaul M, Erkan D, Sammaritano L, Lockshin MD. Assessment of the 2006 revised antiphospholipid syndrome classification criteria. Ann Rheum Dis. 2007;66:927–30.PubMedCentralPubMedCrossRef
9.
Erkan D, Yazici Y, Peterson MG, Sammaritano L, Lockshin MD. A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome. Rheumatology (Oxford). 2002;41:924–9.CrossRef
10.
Asherson RA, Cervera R, Piette JC, et al. Catastrophic antiphospholipid syndrome: clues to the pathogenesis from a series of 80 patients. Medicine (Baltimore). 2001;80:355–76.CrossRef
11.••
Bartholomew JR. Perioperative management of anticoagulation in the patient with the antiphospholipid syndrome in cardiac surgery and cardiac interventions. In: Mandell BF, editor. Perioperative management of the patient with rheumatic disease. 1st ed. New York: Springer; 2012. p. 109–27. This book chapter is a review of the peioperative management of patients with APS undergoing cardiac procedures.
12.
Avcin T, Toplak N. Antiphospholipid antibodies in response to infection. Curr Rheumatol Rep. 2007;9:212–8.PubMedCrossRef
13.
Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood. 2003;101:1827–32.PubMedCrossRef
14.
Pengo V, Biasiolo A, Gresele P, for the Participating Centres of Italian Federation of Thrombosis Centres (FCSA), et al. Survey of lupus anticoagulant diagnosis by central evaluation of positive plasma samples. J Thromb Haemost. 2007;5:925–30.PubMedCrossRef
15.
Pengo V, Tripodi A, Reber G, for the Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis, et al. Update of the guidelines for lupus anticoagulant detection. J Thromb Haemost. 2009;7:1737–40.PubMedCrossRef
16.
Trappe R, Loew A, Thuss-Patience P, Dörken B, Riess H. Successful treatment of thrombocytopenia in primary antiphospholipid antibody syndrome with the anti-CD20 antibody rituximab—monitoring of antiphospholipid and anti-GP antibodies: a case report. Ann Hematol. 2006;85:134–5.PubMedCrossRef
17.
Galli M, Finazzi G, Barbui T. Thrombocytopenia in the antiphospholipid syndrome. Br J Haematol. 1996;93:1–5.PubMedCrossRef
18.
Erkan D, Bateman H, Lockshin MD. Lupus anticoagulant-hypoprothrombinemia syndrome associated with systemic lupus erythematosus: report of 2 cases and review of literature. Lupus. 1999;8:560–4.PubMedCrossRef
19.
Erkan D, Leibowitz E, Berman J, Lockshin MD. Perioperative medical management of antiphospholipid syndrome: hospital for special surgery experience, review of literature, and recommendations. J Rheumatol. 2002;29:843–9.PubMed
20.
Vinet E, Rich E, Senécal JL. Thromboembolism complicating the treatment of lupus anticoagulant hypoprothrombinemia syndrome. J Rheumatol. 2006;33:2088–90.PubMed
21.
Simel D, St. Claire EW, Adams J, Greenberg C. Correction of hypothrombinemia by immunosuppressive treatment of lupus anticoagulant-hypoprothrombinemia syndrome. Am J Med. 1987;83:563–6.PubMedCrossRef
22.
Asherson RA, Chan JK, Harris EN, Gharavi AE, Hughes GR. Anticardiolipin antibody, recurrent thrombosis, and warfarin withdrawal. Ann Rheum Dis. 1985;44:823–5.PubMedCentralPubMedCrossRef
23.
Palareti G, Legnani C, Guazzaloca G, et al. Activation of blood coagulation after abrupt or stepwise withdrawal of oral anticoagulants—a prospective study. Thromb Haemost. 1994;72:222–6.PubMed
24.
Yamamoto T, Ito M, Nagata S, et al. Catastrophic exacerbation of antiphospholipid syndrome after lung adenocarcinoma biopsy. J Rheumatol. 2000;27:2035–7.PubMed
25.
Chouhan VD, Comerota AJ, Sun L, Harada R, Gaughan JP, Rao AK. Inhibition of tissue factor pathway during intermittent pneumatic compression: a possible mechanism for antithrombotic effect. Arterioscler Thromb Vasc Biol. 1999;19:2812–7.PubMedCrossRef
26.
Kakkos SK, Caprini JA, Geroulakos G, Nicolaides AN, Stansby GP, Reddy DJ. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients. Cochrane Database Syst Rev. 2008;4, CD005258.PubMed
27.
Sevitt S. Pathology and pathogenesis of deep vein thrombosis. In: Bergan J, Yao J, editors. Venous problems. Chicago: Year Book; 1976. p. 257–69.
28.
Kraai EP, Lopes RD, Alexander JH, Garcia D. Perioperative management of anticoagulation: guidelines translated for the clinician. J Thromb Thrombolysis. 2009;28:16–22.PubMedCrossRef
29.
Geerts WH, Bergqvist D, Pineo GF, for the American College of Chest Physicians, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:381S–453.PubMedCrossRef
30.
Douketis JD, Berger PB, Dunn AS, for the American College of Chest Physicians, et al. The perioperative management of antithrombotic therapy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:299S–339.PubMedCrossRef
31.
Faltas B, Kouides PA. Update on perioperative bridging in patients on chronic oral anticoagulation. Expert Rev Cardiovasc Ther. 2009;7:1533–9.PubMedCrossRef
32.
Price EA, Jin J, Nguyen HM, Krishnan G, Bowen R, Zehnder JL. Discordant aPTT and anti-Xa values and outcomes in hospitalized patients treated with intravenous unfractionated heparin. Ann Pharmacother. 2013;47(2):151–8.PubMedCrossRef
33.
Muhsin SA, Khianey R, Erkan D. Comment: discordant aPTT and anti-Xa values and outcomes in hospitalized patients treated with intravenous unfractionated heparin. Ann Pharmacother. 2013;47(9):1239–40.PubMedCrossRef
34.
Horlocker TT, Heit JA. Low molecular weight heparin: biochemistry, pharmacology, perioperative prophylaxis regimens, and guidelines for regional anesthetic management. Anesth Analg. 1997;85:874–5.PubMed
35.
Horlocker TT, Wedel DJ, Rowlingson JC, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine evidence-based guidelines (third edition). Reg Anesth Pain Med. 2010;35:64–101.PubMedCrossRef
36.
Silverberg M, Erkan D, Lockshin MD. Hemorrhage in the antiphospholipid syndrome: the challenge of anticoagulation. Arthritis Rheum. 2002;46:S52.CrossRef
37.
Devereaux PJ, Mrkobrada M, Sessler DI, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014.
38.
Bobba RS, Crowther MA. Perioperative management of the patient with immune thrombocytopenic purpura de novo and the thrombocytopenia of antiphospholipid antibody syndrome. In: Mandell BF, editor. Perioperative management of the patient with rheumatic disease. 1st ed. New York: Springer; 2012. p. 129–35.
39.
Tenedios F, Erkan D, Vega J, Ramon G, Kozora E, Lockshin MD. Rituximab in Antiphospholipid Syndrome (RITAPS)—a pilot open-label phase II prospective trial for non-criteria manifestations of antiphospholipid antibodies. Arthritis Rheum. 2013;65(2):464–71.CrossRef
40.
Raflores MB, Kaplan RB, Spero JA. Pre-operative management of a patient with hypoprothrombinemialupus anticoagulant syndrome. Thromb Haemost. 2007;98:248–50.PubMed
41.
Drazin D, Westley Phillips H, Shirzadi A, Drazin N, Schievink W. Neurosurgical management for complicated catastrophic antiphospholipid syndrome. J Clin Neurosci. 2014;21(4):680–3.PubMedCrossRef
42.
Erkan D. Therapeutic and prognostic considerations in catastrophic antiphospholipid syndrome. Autoimmun Rev. 2006;6:98–103.PubMedCrossRef
43.
Deane KD, West SG. Antiphospholipid antibodies as a cause of pulmonary capillaritis and diffuse alveolar hemorrhage: a case series and literature review. Semin Arthritis Rheum. 2005;35:154–65.PubMedCrossRef
44.
Vigué B. Bench-to-bedside review: optimising emergency reversal of vitamin K antagonists in severe haemorrhage—from theory to practice. Crit Care. 2009;13:209.PubMedCentralPubMedCrossRef
45.
Cerrato D, Ariano C, Fiacchino F. Deep vein thrombosis and low-dose heparin prophylaxis in neurosurgical patients. J Neurosurg. 1978;49:378–81.PubMedCrossRef
46.
Iorio A, Agnelli G. Low-molecular-weight and unfractionated heparin for prevention of venous thromboembolism in neurosurgery: a meta-analysis. Arch Intern Med. 2000;160:2327–32.PubMedCrossRef
47.
Cheng JS, Arnold PM, Anderson PA, Fischer D, Dettori JR. Anticoagulation risk in spine surgery. Spine (Phila Pa 1976). 2010;35:S117–24.CrossRef
48.
Stone JH, Amend WJ, Criswell LA. Antiphospholipid antibody syndrome in renal transplantation: occurrence of clinical events in 96 consecutive patients with systemic lupus erythematosus. Am J Kidney Dis. 1999;34:1040–7.PubMedCrossRef
49.
McIntyre JA, Wagenknecht DR. Antiphospholipid antibodies. Risk assessments for solid organ, bone marrow, and tissue transplantation. Rheum Dis Clin N Am. 2001;27:611–31.CrossRef
50.
Raklyar I, DeMarco J, Wu J, Light J, Timbil S, Weinstein A. Anticardiolipin antibody positivity correlates with poor graft survival in renal transplantation for systemic lupus erythematosus [abstract]. Arthritis Rheum. 2005;52:S384–5.
51.
Canaud G, Bienaimé F, Noël LH, et al. Severe vascular lesions and poor functional outcome in kidney transplant recipients with lupus anticoagulant antibodies. Am J Transplant. 2010;10(9):2051–60.PubMedCrossRef
52.
Wagenknecht DR, Becker DG, LeFor WM, McIntyre JA. Antiphospholipid antibodies are a risk factor for early renal allograft failure. Transplantation. 1999;68:241–6.PubMedCrossRef
53.
Forman JP, Lin J, Pascual M, Denton MD, Tolkoff-Rubin N. Significance of anticardiolipin antibodies on short and long term allograft survival and function following kidney transplantation. Am J Transplant. 2004;4:1786–91.PubMedCrossRef
54.
Furmańczyk-Zawiska A, Bączkowska T, Sadowska A, Szmidt J, Chmura A, Durlik M. Antiphospholipid antibodies in renal allograft recipients. Transplant Proc. 2013;45(4):1655–60.PubMedCrossRef
55.
Vaidya S, Sellers R, Kimball P, et al. Frequency, potential risk and therapeutic intervention in end-stage renal disease patients with antiphospholipid antibody syndrome: a multicenter study. Transplantation. 2000;69:1348–52.PubMedCrossRef
56.
Domingues V, Dadhania D, Hartona C, Pastore R, Erkan D. Hospital for Special Surgery—Cornell Protocol for Antiphospholipid Antibody Positive Patients Undergoing Renal Transplantation. 14th International Congress on aPL Abstract Book 2013;316:70.
57.
Cherian J, Gertner E. Recurrent pulmonary embolism despite inferior vena cava filter placement in patients with the antiphospholipid syndrome. J Clin Rheumatol. 2005;11:56–8.PubMedCrossRef
58.
Decousus H, Leizorovicz A, Parent F, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med. 1998;338:409–15.PubMedCrossRef
Metadata
Title
Perioperative Management of Antiphospholipid Antibody-Positive Patients
Authors
Katherine H. Saunders
Doruk Erkan
Michael D. Lockshin
Publication date
01-07-2014
Publisher
Springer US
Published in
Current Rheumatology Reports / Issue 7/2014
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-014-0426-7
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