The antiphospholipid antibody syndrome in paediatric neurosurgery: a problem of haemostasis

The case of a Ii-year-old boy under anticoagulant therapy for a familial an tiphospholipid antibody syndrome (SAAPF), who underwent surgery for a cereb rovascular malformation responsible for an intracerebral haematoma, is repo rted. Antivitamins K (AVK) were changed for unfractioned heparin (HNF), thr ee days before. Heparin was discontinued two hours prior to surgery to obta in a normal peroperative coagulation. A vascular dural fistula was removed without any haemostatic problem. The neurological status rapidly returned t o normal and tomodensitometry at day 1 showed a normal intracranial status. Heparin was readministered at h 16. Thrombocytopenia occurred at day 4 of heparin treatment. The change for a low weight molecular heparinoid, danapa roid (Orgaran(R)), normalized the platelet count. The platelets aggregation tests were negative during thrombopenia. However, the test for antibodies against the PF4-heparin complex with the Elisa technique, was in favour of a heparin induced thrombocytopenia (TIH). In spite of its anecdotic occurre nce due to cumulative thrombotic risks from the association of immunologic disorders (TIH and SAAPF), this case report underlines the Value but also t he risks of anticoagulant therapy in neurosurgery, when patients are at hig h risk for thrombosis. (C) 1999 Editions scientifiques et medicales Elsevie r SAS.