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The most severe form is catastrophic antiphospholipid antibody syndrome (CAPS), which manifests as rapidly progressing thromboses in multiple organ systems leading to multi-organ ischemia. The mainstay management CAPS is anticoagulation and systemic corticosteroids. Antifibrinolytic agents have previously been thought to be relatively contraindicated in CAPS due to the pro-thrombotic nature of the disease; the complex coagulation profile of CAPS can make it difficult to assess the risks and benefits of antifibrinolytic therapy. Also, should a patient with CAPS require cardiopulmonary bypass (CPB) for surgery, it poses a unique challenge in providing appropriate anticoagulation in the setting of prolonged ACT. We present a case of a 32-year-old postpartum female with CAPS requiring heart transplant who safely received intraoperative antifibrinolytic therapy and was successfully anticoagulated during CPB after perioperative plasmapheresis.<\/jats:p>","DOI":"10.1177\/10892532241249782","type":"journal-article","created":{"date-parts":[[2024,5,5]],"date-time":"2024-05-05T22:32:41Z","timestamp":1714948361000},"page":"181-187","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Management of Anticoagulation and Antifibrinolytics in Catastrophic Antiphospholipid Syndrome"],"prefix":"10.1177","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2459-8794","authenticated-orcid":false,"given":"Jee Ha","family":"Park","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, 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