Strategy for Cardiovascular Surgery in Patients with Antithrombin III Deficiency.

Area of Science:

• Cardiology
• Hematology
• Vascular Surgery

Background:

• Antithrombin III (ATIII) deficiency is a rare genetic disorder predisposing individuals to thrombosis, even with minor stimuli.
• Cardiovascular surgery involving heparinization poses significant risks for patients with ATIII deficiency due to potential hypercoagulability.
• Effective perioperative management strategies are crucial for mitigating complications in these high-risk patients.

Purpose of the Study:

• To evaluate the efficacy and safety of Antithrombin III (ATIII) concentrate replacement in patients with ATIII deficiency undergoing cardiovascular surgery.
• To establish optimal ATIII activity targets for perioperative management during cardiac procedures.

Main Methods:

• A case series of five patients with ATIII deficiency undergoing cardiovascular surgery who received ATIII concentrate.
• Monitoring of ATIII activity levels preoperatively and postoperatively.
• Management of activated clotting time (ACT) during cardiopulmonary bypass.

Main Results:

• ATIII concentrate administration successfully maintained preoperative ATIII activity at ≥120% and postoperative activity at ≥80%.
• All five patients experienced successful surgical outcomes without postoperative hemorrhage or thrombosis.
• Activated clotting time (ACT) was maintained above 400 seconds during cardiopulmonary bypass.

Conclusions:

• Perioperative ATIII replacement is essential for patients with ATIII deficiency undergoing cardiovascular surgery.
• Achieving specific ATIII activity targets (preoperative ≥120%, postoperative ≥80%) is critical for preventing complications.
• Long-term anticoagulation may be necessary for hereditary ATIII deficiency patients with a history of thrombosis.