Outcomes of patients with antiphospholipid syndrome after pulmonary endarterectomy

Camous, J P; Decrombecque, Thibaut; Louvain-Quintard, Virginie; Doubine, Sylvie; Dartevelle, Philippe; Stéphan, François

doi:10.1093/ejcts/ezt572

Cited by 30 publications

(27 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Early transient neurological complications and recurrence of thrombotic events are more common in patients with APS after PEA [16,17]. They did not occur in our patient.…”

Section: Discussioncontrasting

confidence: 39%

“…Careful and strict anticoagulation was applied later. Compared with the controls, the patients with APS have significantly lower platelet counts [16]. Thrombocytopenia is reported with prevalence's between 30% and 46% in patients with primary APS [18], but it is usually moderate (>50 × 10 9 /L) and not require intervention.…”

Section: Discussionmentioning

confidence: 90%

“…Also preoperative platelet count could be significantly lower in patients with APS; no specific guidelines are available for managing thrombocytopenia in these patients [19]. While one of possible explanations for the aetiology of thrombocytopenia in APS could be the presence of autoantibodies to platelet surface membrane glycoproteins, same as in idiopathic thrombocytopenic purpura, patients are usually given similar treatment such as steroids, intravenous immunoglobulins, plasma exchange or splenectomy [16,19]. In this case, the time of severe platelet count drop-off was approximately 6 days after heparin prescription and caused the suspicion of heparin-induced thrombocytopenia; heparin was replaced by fondaparinux.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Case report: Life-saving pulmonary endarterectomy for a young female with primary antiphospholipid syndrome complicated by severe chronic thromboembolic pulmonary hypertension

Palevičiūtė

Malickaitė

Matačiūnas

et al. 2018

Seminars in Cardiovascular Medicine

View full text Add to dashboard Cite

Background: Prothrombotic state and impaired clot dissolution can contribute to the occurrence of chronic thromboembolic pulmonary hypertension in primary antiphospholipid syndrome. Pulmonary endarterectomythe surgical removal of the organized thromboembolic material from the proximal pulmonary arteries -is the procedure of choice and potentially a curative option for patients with chronic thromboembolic pulmonary hypertension, including patients with antiphospholipid syndrome. We report an exceptionally severe and complicated case with favourable outcome.Case presentation: We present a case of a successful high risk pulmonary endarterectomy in a 29-year-old female with primary antiphospholipid syndrome and end-stage chronic thromboembolic pulmonary hypertension. Despite highly complicated perioperative course an impressive improvement in symptoms and functional status was achieved.Conclusion: We hope that this complicated but successfully managed case of a combination of two rare diseases will arouse earlier suspicion and timely diagnosis for such patients and will encourage physicians to promptly refer the suitable patients to a pulmonary endarterectomy team.It is important to remember that severe thrombocytopenia may occur in patients with antiphospholipid syndrome. Seminars in Cardiovascular Medicine 2018; 24:1-8

show abstract

“…Early transient neurological complications and recurrence of thrombotic events are more common in patients with APS after PEA [16,17]. They did not occur in our patient.…”

Section: Discussioncontrasting

confidence: 39%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Case report: Life-saving pulmonary endarterectomy for a young female with primary antiphospholipid syndrome complicated by severe chronic thromboembolic pulmonary hypertension

Palevičiūtė

Malickaitė

Matačiūnas

et al. 2018

Seminars in Cardiovascular Medicine

View full text Add to dashboard Cite

show abstract

“…In addition, APS patients may present with thrombocytopenia after catheterization or pulmonary endarterectomy, even without developing HIT. 3,4 In our case, invasive procedures might have augmented the thrombotic tendency, resulting in platelet consumption despite no clinical thrombotic events. We reluctantly withheld anticoagulation in the early postoperative period.…”

Section: Discussionmentioning

confidence: 66%

Perioperative anticoagulation management in antiphospholipid syndrome

Ishida

Masuda

Kohno

et al. 2015

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

Patients with antiphospholipid syndrome are at increased risk of developing thrombotic and hemorrhagic complications after cardiac surgery, and may have abnormal coagulation tests and develop thrombocytopenia after invasive procedures, which can complicate the perioperative management of anticoagulant therapy. We describe a patient with chronic thromboembolic pulmonary hypertension and antiphospholipid syndrome, who presented with prolonged activated partial thromboplastin and activated clotting times, and developed thrombocytopenia after the catheterization workup. We performed pulmonary endarterectomy and successfully managed anticoagulation by restricting heparin use at the time of surgery and monitoring the heparin effect by measuring heparin concentrations during cardiopulmonary bypass.

show abstract

“…45 There are few reports of a positive outcome of PTE in patients with APS, with aPL positivity not affecting the rate of early mortality and major complications, except for neurological sequelae and thrombocytopenia. [82][83][84][85][86][87][88] Unfortunately, approximately 20 to 40% of CTEPH patients are not operable due to the distal and inaccessible nature of the lesions or to comorbidities. In up to 35% of patients, the disease persists or reoccurs after PTE.…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

Lung Disease in Antiphospholipid Syndrome

Maioli

Calabrese

Capsoni

et al. 2019

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Antiphospholipid syndrome (APS) is an acquired prothrombotic condition characterized by vascular thrombosis and/or obstetric complications, in the persistent positivity of circulating antiphospholipid antibodies (aPLs). The clinical spectrum of manifestations associated with aPL positivity is progressively expanding, including the description of several lung manifestations. The most common pulmonary involvement related to aPL positivity is pulmonary embolism (PE), which has been reported to occur in 14.1% of APS patients during disease course. PE acknowledges a purely thrombotic etiology and thus might be accounted as a criterion for APS, making imperative to test aPL in young subjects with unprovoked PE. Pulmonary hypertension (PH) can manifest in APS patients, being the second most common lung complication of the syndrome, with a prevalence ranging between 1.8 and 3.5%. aPL-positive patients might present PH following a PE, might develop pulmonary arterial hypertension associated with connective tissue disease, or might present pulmonary venous hypertension due to Libman–Sacks endocarditis. Additional lung manifestations, such as diffuse alveolar hemorrhage, acute respiratory distress syndrome, and pulmonary fibrosis, are rarely described in APS patients; it is still not clear whether in these settings aPLs exert a pathogenic role or is a mere epiphenomenon. Hereby we discuss impact, clinical presentation, histopathologic findings, etiology, and treatment of each aPL-associated lung manifestation.

show abstract

Outcomes of patients with antiphospholipid syndrome after pulmonary endarterectomy

Abstract: Neurological complications and severe thrombocytopenia were more common after pulmonary endarterectomy in patients with than without APS. Haemodynamic results and ICU mortality rate were similar in the two groups.

Cited by 30 publications

References 23 publications

Case report: Life-saving pulmonary endarterectomy for a young female with primary antiphospholipid syndrome complicated by severe chronic thromboembolic pulmonary hypertension

Case report: Life-saving pulmonary endarterectomy for a young female with primary antiphospholipid syndrome complicated by severe chronic thromboembolic pulmonary hypertension

Perioperative anticoagulation management in antiphospholipid syndrome

Lung Disease in Antiphospholipid Syndrome

Contact Info

Product

Resources

About