[A patient with congenital antithrombin III deficiency who underwent laparoscopic renal resection]

A 66-year-old man with congenital antithrombin III (ATIII) deficiency was scheduled to undergo laparoscopic renal resection. On admission the plasma ATIII activity was as low as 56%. After giving ATIII intravenously, the plasma ATIII activity increased to 103% on the day of surgery. It is usually difficult to monitor ATIII during surgery. Instead, we measured activated clotting times (ACTs). The ACT before operation was 178 seconds. During the operation, the ACT dropped to 81 seconds. We administered 3,000 units of heparin, and the ACT increased to 182 seconds. After surgery, the plasma ATIII activity was 68%. We managed the ACT activity to a target value of 100% postoperatively, until the patient was switched from heparin to oral warfarin. He was discharged without complications 10 days after surgery. In this patient, the ACT decreased during the operation, as did the ATIII activity. Although the half-life of the ATIII preparation was 3 days, it appeared that the ATIII activity, which was high preoperatively, decreased during the operation. Coagulation abnormalities could be managed quickly by measuring ACT. Our results suggest that the measurement of ACT is an effective technique for the intraoperative monitoring of patients with congenital ATIII deficiency.