Surgery in patients with congenital antithrombin III deficiency

A retrospective study is presented of 23 patients with congenital antithrombin (AT) III deficiency who underwent 57 operations of various types. Thromboprophylaxis was given in 28 operations. Dextran was used in most cases, sometimes in combination with specific AT III concentrate. No patient given AT III concentrate alone or in combination with other methods had signs of thromboembolism. Deep venous thrombosis followed four of the operations with prophylaxis (3 patients). After the 29 operations without prophylaxis there were three cases of deep venous thrombosis, one with clinical signs of pulmonary embolism and another with superficial thrombophlebitis. Despite its inherent drawbacks, this retrospective study indicated that AT III concentrate can effectively prevent postoperative thromboembolism. But as the selection criteria for thromboprophylaxis are difficult to evaluate, a prospective study should be of great value.