• Emanuele Rezoagli, Nicoletta Barzaghi, Mark Crowther, Francesco Dentali, and Fulvio Pomero.
• From the Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
• A A Pract. 2019 Oct 15; 13 (8): 306-309.

AbstractWe report the clinical case of a septic patient with antiphospholipid syndrome who developed ischemia in all 4 limbs, despite a normal systemic blood pressure. Prolonged coagulation times suggested a hemorrhagic diathesis, requiring transfusion of fresh-frozen plasma and discontinuation of heparin infusion. In contrast, the study of the viscoelastic properties of the clot by thromboelastography suggested an uncontrolled activation of the coagulation cascade. This observation led to the reintroduction of heparin with improvement in the patient's laboratory findings. Anesthesiologists should consider thromboelastography to correct coagulopathies in patients with septic shock in the presence of antiphospholipid antibodies.

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