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CARDIOVASCULAR ANESTHESIOLOGY

Management of a Patient with Lupus Anticoagulant and Antiphospholipid Syndrome for Off-Pump Coronary Artery Bypass Grafting Using the Hepcon® System

Karinne Jervis, MD^*, Venkatachalam Senthilnathan, MD^*, and Adam B. Lerner, MD^*

From the Departments of *Anesthesiology, and Cardiac Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Address correspondence and reprint requests to Adam B. Lerner, MD, Department of Anesthesia, BIDMC, 1 Deaconess Road CC470, Boston, MA 02215. Address e-mail to alerner{at}bidmc.harvard.edu.

Abstract

Patients with serum lupus anticoagulant antibodies (LAC) with or without antiphospholipid syndrome who present for cardiac surgery provide a unique set of challenges. Chief among these are the interference with anticoagulation monitoring by LAC. We present a case of such a patient who presented to us for coronary artery bypass grafting. We follow with a review of LAC and antiphospholipid syndrome and present a strategy for ensuring adequate anticoagulation during cardiac surgery in the background of previously published reports.