Strategy for Cardiovascular Surgery in Patients with Antithrombin III Deficiency

• Published in: Annals of Thoracic and Cardiovascular Surgery Vol. 24; no. 4; pp. 187 - 192
• Main Authors: Nishimura, Yoshiyuki, Takagi, Yasushi
• Format: Journal Article
• Language: English
• Published: Japan The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery 01.01.2018
• Subjects: antithrombin III deficiency; cardiovascular surgery; Original; cardiovascular surgery; antithrombin III deficiency
• ISSN: 1341-1098; 2186-1005
• DOI: 10.5761/atcs.oa.18-00030

Antithrombin III (ATIII) deficiency is a rare disorder in which thrombosis can be induced by stimuli that do not usually lead to thrombus formation, including minor injuries and surgery. Therefore, patients with ATIII deficiency undergoing cardiovascular surgery that involves heparinization require careful perioperative management. We experienced five patients with ATIII deficiency who underwent cardiovascular surgery and were managed with ATIII replacement. By administration of ATIII concentrate, preoperative ATIII activity was maintained at ≥120% and postoperative ATIII activity at ≥80%. All five patients were treated successfully without postoperative complications such as hemorrhage or thrombosis. In patients with ATIII deficiency undergoing cardiac surgery, it is important to perform ATIII replacement to achieve preoperative ATIII activity ≥120% and postoperative ATIII activity ≥80%, while the activated clotting time (ACT) is maintained at >400 seconds during cardiopulmonary bypass. In addition, long-term postoperative anticoagulant therapy is necessary in hereditary ATIII deficiency patients with a history of thrombosis.