Pseudomyxoma of the right atrium in a patient with heparin-associated thrombocytopenia and antiphospholipid antibodies

Autor: G. Chiaudani, E. Domenegati, M. Maurelli, Piero Ceriana, T. Bianchi, Alessandro Locatelli, A. Pagnin
Rok vydání: 1995
Předmět:
Zdroj: Journal of Cardiothoracic and Vascular Anesthesia. 9:308-311
ISSN: 1053-0770
DOI: 10.1016/s1053-0770(05)80327-1
Popis: NACTIVATION of the hemostatic mechanism must be achieved before starting cardlopulmonary bypass (CPB). This is currently obtained with heparln, a highly effective anticoagulant with few side effects and with an antidote available. Although its action on coagulant proteins is well defined, its interaction with platelets is complex: A mild thrombocytopenia after heparln administration is a wellknown phenomenon,I but eciually well-known is the possibility that severe thrombocytopenla and thrombosis can occur after contact with heparin. The former effect is of trivial importance and is secondary to a platelet agglutination, but the latter is a potentially lethal complication mediated by an immune mechanism. 2 However, this is not the only clinical condition characterized by the coexistence of thrombocytopenia and thrombosis; an acquired circulating factor also called lupus anticoagulant 3 can induce the same syndrome. The biologic action of this immunoglobulin is directed against anionic phosphollpids; hence it is also called antiphospholipid antibody. This is mainly found in the serum of patients affected by systemic lupus erythematosus (prevalence of about 10%) but can also be idiopathic, secondary to treatment with some drugs (procainamlde, phenothiazines), or to some autoimmune disorders. A case is reported of a patient with both heparin-dependent and antiphosphohpid antibodies who required cardiac surgery.
Databáze: OpenAIRE
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