{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T13:48:39Z","timestamp":1774878519322,"version":"3.50.1"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Egypt Heart J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antiphospholipid syndrome (APS) is a prothrombotic disorder that presents significant challenges during cardiovascular surgery due to its high risk of both thrombotic and hemorrhagic complications. Perioperative management of anticoagulation, particularly with heparin, requires careful balancing to prevent catastrophic outcomes such as thromboembolism or excessive bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>The patient was a 66-year-old man. Two years prior, he was diagnosed with deep vein thrombosis (DVT), and direct oral anticoagulant (DOAC) therapy was initiated. Further evaluation in the cardiology department revealed elevated anticardiolipin antibody levels, leading to a diagnosis of APS. While on DOAC therapy, he was found to have severe aortic valve stenosis caused by a bicuspid aortic valve and 45-mm dilation of the ascending aorta. Surgical intervention was deemed necessary, and the operation was performed. As activated clotting time (ACT) tends to be elevated in APS, intraoperative heparin concentration was closely monitored. The surgery proceeded without perioperative embolic events, and the patient had an uneventful postoperative course.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We report a case of open-heart surgery in a patient with APS, where perioperative embolic events were successfully avoided through close monitoring of blood heparin concentrations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s43044-026-00731-w","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T12:56:16Z","timestamp":1774875376000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Heparin protocols in cardiovascular surgery for antiphospholipid syndrome: a clinical case report"],"prefix":"10.1186","volume":"78","author":[{"given":"Tomohiro","family":"Nakajima","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Iba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsuyoshi","family":"Shibata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuhei","family":"Miura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeko","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidemichi","family":"Kouzu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuyoshi","family":"Kawaharada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"issue":"2","key":"731_CR1","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.ejcts.2007.11.004","volume":"33","author":"H Gorki","year":"2008","unstructured":"Gorki H, Malinovski V, Stanbridge RDL (2008) The antiphospholipid syndrome and heart valve surgery. Eur J Cardiothorac Surg 33(2):168\u2013181. https:\/\/doi.org\/10.1016\/j.ejcts.2007.11.004","journal-title":"Eur J Cardiothorac Surg"},{"key":"731_CR2","doi-asserted-by":"publisher","unstructured":"Koniari I, Siminelakis SN, Baikoussis NG, Papadopoulos G, Goudevenos J, Apostolakis E (2010) Antiphospholipid syndrome; its implication in cardiovascular diseases: A review. J Cardiothorac Surg 5(1). https:\/\/doi.org\/10.1186\/1749-8090-5-101","DOI":"10.1186\/1749-8090-5-101"},{"key":"731_CR3","doi-asserted-by":"publisher","unstructured":"Nakasu A, Ishimine T, Yasumoto H, Tengan T, Mototake H (2018) Mitral valve replacement for Libman-Sacks endocarditis in a patient with antiphospholipid syndrome secondary to systemic lupus erythematosus. J Surg Case Rep 2018(4). https:\/\/doi.org\/10.1093\/jscr\/rjy069","DOI":"10.1093\/jscr\/rjy069"},{"issue":"2","key":"731_CR4","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.jtcvs.2003.07.016","volume":"127","author":"Y Berkun","year":"2004","unstructured":"Berkun Y, Elami A, Meir K, Mevorach D, Naparstek Y (2004) Increased morbidity and mortality in patients with antiphospholipid syndrome undergoing valve replacement surgery. J Thorac Cardiovasc Surg 127(2):414\u2013420. https:\/\/doi.org\/10.1016\/j.jtcvs.2003.07.016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"731_CR5","doi-asserted-by":"publisher","unstructured":"Bernardi M, Spadafora L, Andaloro S et al (2024) Management of Cardiovascular Complications in Antiphospholipid Syndrome: A Narrative Review with a Focus on Older Adults. J Clin Med 13(11). https:\/\/doi.org\/10.3390\/jcm13113064","DOI":"10.3390\/jcm13113064"},{"key":"731_CR6","doi-asserted-by":"publisher","unstructured":"Yoshinaga K, Otsuka Y, Furukawa T, Amitani S, Kimura N, Sanui M (2021) Correlation between activated clotting time monitoring and heparin concentration measurement in a patient with antiphospholipid syndrome during cardiac valve surgery: a case report. JA Clin Rep 7(1). https:\/\/doi.org\/10.1186\/s40981-021-00427-x","DOI":"10.1186\/s40981-021-00427-x"},{"issue":"2","key":"731_CR7","doi-asserted-by":"publisher","first-page":"206","DOI":"10.4103\/aca.aca_228_20","volume":"25","author":"SA Malviya","year":"2022","unstructured":"Malviya SA, Deng Y, Gilani SO, Hendon AA, Nikolaidis MA, Moseley MS (2022) Management of perioperative anticoagulation in a patient with antiphospholipid antibody syndrome undergoing cardiac surgery: A case report. Ann Card Anaesth 25(2):206\u2013209. https:\/\/doi.org\/10.4103\/aca.aca_228_20","journal-title":"Ann Card Anaesth"},{"key":"731_CR8","doi-asserted-by":"publisher","unstructured":"Le Ho Y, Ahmad Zaidi NA, Salleh A, Abdul Kareem BA (2021) Aortic valve surgery for aortic regurgitation caused by Libman-Sacks endocarditis in a patient with primary antiphospholipid syndrome: a case report. J Cardiothorac Surg 16(1). https:\/\/doi.org\/10.1186\/s13019-021-01458-2","DOI":"10.1186\/s13019-021-01458-2"}],"container-title":["The Egyptian Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43044-026-00731-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s43044-026-00731-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43044-026-00731-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T12:56:16Z","timestamp":1774875376000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s43044-026-00731-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["731"],"URL":"https:\/\/doi.org\/10.1186\/s43044-026-00731-w","relation":{},"ISSN":["2090-911X"],"issn-type":[{"value":"2090-911X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]},"assertion":[{"value":"10 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"A written informed consent of all details\/images relating to the patient for publication was obtained from the patient.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"20"}}