Anesthesia management in a patient with systemic lupus erythematosus and left ventricular thrombus

Stroke with postoperative visual loss as the first clinical manifestation of antiphospholipid antibody syndrome: Case report

“…In addition, APS is an autoimmune disease characterized by the presence of lupus anticoagulant antibodies that predispose the individual to thrombotic events. The pathophysiological mechanism involves the binding of antiphospholipid antibodies to glycoprotein I (β2GPI), a plasma protein that avidly binds to phospholipid surfaces, positively regulating the expression of prothrombotic cell-adhesion molecules, including E -selectin and tissue factor [6] , [7] . Ischemic stroke and transient ischemic attacks are the most common arterial events in patients with APS.…”

Anaesthetic considerations for patients with antiphospholipid syndrome undergoing non-cardiac surgery

“…However, there is no universally accepted withdrawal regimen, and there can be debate in cases with both perioperative thrombotic and bleeding risks. 49 Procedures associated with low risk of bleeding, as shown in Table 3, 50,51 can usually be performed without interrupting anticoagulation, and the limited blood loss in these procedures can be controlled with local haemostatic pressure. 50 Although aspirin increases the risk of major bleeding, Saunders et al.…”

“…50 However, if bleeding persists even 72 h after surgery, options such as low-dose bridging anticoagulation or restarting warfarin without bridging anticoagulation, can be considered. 49 The timing of resumption of antithrombotic therapy is based on an appropriate assessment of the patient’s clinical relative risks of bleeding and risks of thrombosis. If an epidural catheter has been placed after epidural analgesia or neuraxial anaesthesia, removal of the catheter is recommended 1 h before restarting unfractionated heparin or 4 h before restarting LMWH, according to ASRA guidelines.…”

“…91,99 Even if optimal anticoagulation is restarted as soon as possible and early mobilization is achieved, patients with APS should be closely followed with routine tests such as chest X-ray, ECG, and laboratory tests, to check for thrombosis or bleeding complications during the first 2 weeks after surgery. 49…”