ESRA Academy. Biosca E. Sep 8, 2016; 138502; 0362 Topic: Anticoagulation- Haemorrhagic Complications
Elena Biosca
Elena Biosca

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Background and Aims:

A 70-year-old woman, with history of smoking, severe COPD and antiphospholipid syndrome(APL) since 1992 treatment with sintrom. She arrived to the emergency room with heamoptoic sputum. Blood test displayed an INR of 5,74. We proceed to reversal anticoagulation and the patient remained wihtout antitrombotic therapy. The following days her lower extremities suffered from pain and coldness. It confirmed arterial ischemia asking preoparative evaluation to performing thrombectomy.

The APL is a systemic autoimmune disorder defined by arterial or venous thrombosis and/or pregnancy morbidity in the presence of antiphospholipid antibodies.  
It´s mainstay treatment is antitrombotic therapy, but duration and intensity remain controversial as intensity is the main risk factor of bleeding. A surgical insult may trigger widespread thrombosis. It will require pre, intra and post perioperative control. The frequent presence of thrombocytopenia, paradoxical prolongation of aPTT or complications such as bleeding, pose a challenge for successful management.


Preoperatively we started with LMWH therapeutic-dose, stopping 24h before surgery and to prepared packed red cell and platelet pool.
Besides highlights of thrombocytopenia, so it started with corticosteroids and immunoglobulin therapy.
Intraoperatively, despite its evolved bronchopathy, we opted for general anesthesia, avoiding perform neuraxial anesthesia.


Surgery was uneventful. Transfusions were not necessary and LMWH therapeutic dose was restarted the following day.
After days of observation, she was discharged with LMWH prescribed indefinitely.


Periods without anticoagulation should be minimized, but there is no consensus regarding intraoperative management of anticoagulation in APL.The optimal approach should be multidisciplinar and individualized and requires balancing hazard of recurrence as well as of bleeding.

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