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Perioperative management of venous recanalization in a patient with inherited antithrombin deficiency: case report
Julie Benzakine1,2, Carla Rial1,2, Nassim Mohamedi3
1Innovative Therapies in Haemostasis, INSERM, University Paris Cité, Paris, France.
Background:
Inherited antithrombin (AT) deficiency (ATD) is a severe thrombophilia causing venous thromboembolism, which can be complicated by postthrombotic syndrome (PTS). Venous recanalization, used to treat PTS, often requires a temporary withdrawal of anticoagulant therapy. In ATD patients, there is a risk of insufficient perioperative anticoagulation due to altered heparin response.
Key Clinical Question:
There is no consensus on how to manage perioperative anticoagulation in ATD patients.
Clinical Approach:
Warfarin-unfractionated heparin transition could be a more reliable strategy than low-molecular-weight heparin transition because unfractionated heparin anti-Xa activity not only reflects heparin-bound AT but also AT's activity, which correlates strongly with therapeutic anticoagulation. Biological monitoring could thus decrease the number of plasma-derived AT supplementation.
Conclusion:
This study describes a successful perioperative management of anticoagulation for venous recanalization that could be suggested to type 1 ATD patients with PTS.
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