• Thrombosis research · Sep 2017

    Case Reports

    A case that illustrates the challenges of managing pregnant patients with antithrombin deficiency: More questions than answers.

    • Leslie Skeith, Andrew Aw, Julia Hews-Girard, and Natalia Rydz.
    • Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. Electronic address: leslie.skeith@gmail.com.
    • Thromb. Res. 2017 Sep 1; 157: 1-6.

    AbstractUsing an illustrative case of a patient with antithrombin (AT) deficiency who developed a recurrent venous thromboembolism (VTE) in pregnancy despite therapeutic low-molecular-weight heparin (LMWH), we highlight what is known in the literature and address areas of controversy through a series of questions around the case. The questions we address include the role of anti-Xa monitoring for patients with past VTE on antepartum LMWH, what treatment regimen is recommended for pregnant patients who develop a recurrent VTE while on therapeutic anticoagulation, the role of antepartum AT concentrate prophylaxis, and the management of labor/delivery, epidural anesthesia and postpartum anticoagulation. We also describe practical considerations for use of AT concentrate, including teaching our patient to self-infuse AT concentrate at home with support of a hemophilia treatment center (HTC), and the direct and indirect costs of AT concentrate for secondary prophylaxis.Copyright © 2017 Elsevier Ltd. All rights reserved.

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