Belkız UYAR, Şenol KOBAK, Emin Alp ALAYUN, İhsan Sami UYAR, Faik Fevzi OKUR

Antiphospholipid syndrome in terms of cardiovascular surgery

Antifosfolipit sendromu (APS) temelde çeşitli hiperkoagülasyonbozuklukları ile karakterize nadir bir sendromdur. Busendromun klinik bulguları arasında arteriyel veya venöztrombozlar, tekrarlayan pulmoner embolizm, kapak hastalıkları,intrakardiyak trombüs oluşumları, pulmoner hipertansiyon,koroner arter hastalığı ve dilate kardiyomiyopati sayılabilir.Arteriyel veya venöz tromboz veya tekrarlayan düşük öyküsüolan ve antikardiyolipin antikorları, antifosfolipit antikorlar diyede bilinen anti-beta 2-glycoprotein-1 antikorları veya lupusantikoagülan antikorları pozitif olan bir hastada kesin tanıkonulabilir. Tromboz insidansı şu dönemlerde en yüksektir: 1)varfarinin kesilmesi nedeniyle ameliyat öncesi dönem; 2) varfarinveya heparin tedavisine rağmen potansiyel hiperkoagülabilitenedeniyle ameliyat sonrası dönem; 3) uygun antikoagülasyontedavisi başlanmadan önce ameliyat sonrası dönem. İmmünkomplekslerin birikimi sonucu kapakçıkların düzensizkalınlaşması vejetasyona ve kapakçık disfonksiyonuna nedenolabilir. En yaygın etkilenen kapak mitral kapak olup bunu aortikve triküspit kapaklar takip eder. APSli hastalarda trombozriskinin yüksek olması nedeniyle kardiyopulmoner baypassırasında antikoagülasyon dozu dikkatli ayarlanmalıdır. Ameliyatsırası ve sonrası dönemde antikoagülasyonun iyi ayarlanmasıile kanama ve tromboz riskinin azaltılması için multidisiplineryaklaşımlar gereklidir. Antifosfolipit sendromlu hastaların kalpdamar cerrahisi sırasında antikoagülasyon ayarlamaları hakkındadaha fazla prospektif çalışmaya ihtiyaç vardır.

Kalp damar cerrahisi açısından antifosfolipit sendromu

Antiphospholipid syndrome (APS) is a rare syndrome mainlycharacterized by several hypercoagulation disorders. Clinicalfindings of this syndrome include arterial or venous thrombosis,recurrent pulmonary embolism, valve diseases, intracardiacthrombus formations, pulmonary hypertension, coronary arterydisease, and dilated cardiomyopathy. A definitive diagnosiscan be made in a patient with history of arterial or venousthrombosis or recurrent abortions and positive for anticardiolipinantibodies, anti-beta 2-glycoprotein-1 antibodies -also known asantiphospholipid antibodies- and/or lupus anticoagulants. Theincidence of thrombosis is highest during the following periods:1) preoperative period due to the withdrawal of warfarin;2) postoperative period due to potential hypercoagulabilitydespite warfarin or heparin therapy; and 3) postoperative periodbefore the start of adequate anticoagulation treatment. Irregularthickening of the valve leaflets due to deposition of immunecomplexes may lead to vegetation and valve dysfunction. Themost commonly affected valve is the mitral valve, followedby the aortic and tricuspid valves. Anticoagulation dosageshould be adjusted carefully during cardiopulmonary bypassdue to the high risk of thrombosis in patients with APS.Multidisciplinary approaches are needed to reduce risk ofbleeding and thrombosis during peri- and postoperative periodsby adequate anticoagulation adjustment. Further prospectivestudies are required on anticoagulation adjustments in patientswith APS during cardiovascular surgery.

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