[HSF] Antiphospholipid Syndrome

[Michael Firstenberg]

For some reason, we have seen a lot of anti-phos. syndromes - and they
usually are not pretty.  The problem is that we figure it out
post-operatively either when they bleed to death or they clot to death.  In
my limited experience (most seen as a Fellow), these are the patients who
clot all of their grafts the first day or so.  Anti-coag is a huge problem
(like clotting on high dose heparin!) and often other drugs like
bivaldirudin are need - which can also be a real problem.  I would find a
hematologist who is interested in "benign heme" (although these can be far
more malignant from a CT standpoint) to help sort these things out.  I think
of this as like radiation heart disease - the problem is always much worse
than it looks.

good luck

-michael


On 1/17/07, claudia miranda <cvteles at gmail.com> wrote:
>
> Dear listmembers:
>
> First of all: are you sure this is antiphospholipid syndrome?
> Has this guy undergone a full thrombophilia screening panel?Protein C, S,
> ATIII, Leiden, prothrombin mutation, and MTHFR mutation plus dosing
> of factor VIII, IX, X and XI ?
> Second: has he received any heparin in the last six months?
>
> I will send you a .pdf about anticoagulation in such patients off list.
> Best.
>
> Claudia Teles, MD
> Hemostasis - Lamina Laboratories
> Pro Cardiaco - Rio de Janeiro
>
>
> 2007/1/17, Nasser F. Abou'Seada <nfaabouseada at gmail.com>:
> >
> > Good question Hal !!!
> >
> > NFA
> >
> > > -----Original Message-----
> > > From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> > > bounces at lists.hsforum.com] On Behalf Of hgrmd at aol.com
> > > Sent: Wednesday, January 17, 2007 9:51 AM
> > > To: OpenHeart-L at lists.hsforum.com
> > > Subject: Re: [HSF] Antiphospholipid Syndrome
> > >
> > > Tohru,
> > >   If you reread my post, you'll know that I have the same exact
> > concerns.
> > A
> > > malignancy is certainly in the differential.  My plan is to get a fast
> > cardiac MR to
> > > further characterize the mass.  In addition, I will likely get a
> > transcatheter biopsy.  All
> > > in all, however, I think a man with a known phospholipid deficiency,
> > history of DVT,
> > > and ischemic toes is much more likely to have clot rather than tumor.
> > >   Tohru, if it is clot, would you operate?
> > > Hal
> > >
> > >
> > > -----Original Message-----
> > > From: toruasai at belle.shiga-med.ac.jp
> > > To: OpenHeart-L at lists.hsforum.com
> > > Sent: Wed, 17 Jan 2007 9:03 AM
> > > Subject: Re: [HSF] Antiphospholipid Syndrome
> > >
> > >
> > > Hal
> > > I had a similar CT picture ( RA lumen occlusion by laminated clot like
> > > tissue ) in young Japanese male patient a few years ago. I was about
> to
> > > operate. The mass by trans-catheter biopsy turned out to be cardiac
> > > malignant lymphoma. It dramatically responded to IV chemotherapy and
> > > disappeared. I did not have to operate on him.
> > >
> > > My case may have nothing to do with yours. But I would recommend
> biopsy
> > of
> > > the mass by catheter. Since it shows unusual growth. By the way, why
> did
> > you
> > > know the mass was clot?
> > > --
> > > Tohru Asai
> > >
> > > > I  might consider a transjugular
> > > > biopsy. If possible, I think the  clot needs to be removed and a
> maze
> > carried
> > > > out.
> > > >  However, I'm unsure  how to handle the perioperative
> anticoagulation.
> > >
> > >
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