Management of Pregnancy in Women with Antithrombin III Congenital Defect: Report of Four Cases

Summary

Four pregnant women with antithrombin III congenital deficiency underwent thrombosis prophylaxis including oral antico–agulants administered from the 16–18th week to the 36–37th week of pregnancy, subcutaneous heparin before the 16–18th week and after the 36–37th week, and a single infusion of AT III concentrate in the peripartum period in order to obtain a minimal level of 0.8 U/ml of AT III functional activity. The level of circulating AT III after the concentrate infusion needs to be evaluated by functional methods, because of a consistent amount in the concentrates of inactive AT III immunoreactive material. No thrombotic or haemorrhagic complication occurred after starting prophylaxis in any woman either in any newborn.

Keywords

AT III congenital deficiency - Pregnancy - Thrombosis prophylaxis - Heparin - Oral anticoagulants - AT III concentrate

• References

• 1 Cosgriff TM, Bishop DT, Hershgold EJ. et al. Familial antithrombin HI deficiency: its natural history, genetics, diagnosis and treatment. Medicine 1982; 62: 209-220
• 2 Hellgren M, Tengborn L, Abildgaard U. a Pregnancy in women with congenital antithrombin III deficiency: experience of treatment with heparin and antithrombin. Gynecol Obstet Invest 1982; 14: 127-141
• 3 Marciniak E, Gockerman IP. Heparin-induced decrease in circulating antithrombin III. Lancet 1977; 11: 581-584
• 4 Green PJ. Antithrombin III and subcutaneous heparin. Lancet 1980; 374-375
• 5 Hellgren M, Nigards E-B. Long-term therapy with subcutaneous heparin during pregnancy. Gynecol Obstet Invest 1982; 13: 76-89
• 6 Chamontin M, Guittard J, Laroche M, Boneu B, Salvador M. Traitement d’une thrombose veineuse profonde en presence d’un deficit congenital en antithrombine III. A propos de l’utilisation de concentres purifies Arch Mai Coeur 1984; 77: 1064-1067
• 7 Brandt P, Stenbjerg S. Subcutaneous heparin for thrombosis in pregnant women with hereditary antithrombin III deficiency. Lancet 1979; 100-101
• 8 Samson D, Stirling Y, Woolf L, Howarth D, Seghatchian MJ, De Chazal R. Management of planned pregnancy in a patient with congenital antithrombin III deficiency. Br J Haematol 1984; 56: 243-249
• 9 Shander K, Kirchhoff PG, Popov-Cenic S, Budde U. Pregnancy and delivery in hereditary antithrombin III deficiency with thromboembolic complication. Haemostasis. 1985 15. 80 (Abstr.)
• 10 Leclerc JR, Geerts W, Panju A, Nguyen P, Hirsh J. Management of anti-thrombin III deficiency during pregnancy without administration of anti-thrombin III. Thromb Res 1986; 41: 567-573
• 11 Zucker ML, Gomperts ED, Marcus RG. Prophylactic and therapeutic use of anticoagulants in inherited antithrombin III deficiency. S Afr Med J 1976; 50: 1743-1748
• 12 Michiels JJ, Stibbe J, Vellenga E, van Vliet HH D M. Prophylaxis of thrombosis in. antithrombin Ill-deficient women during pregnancy and delivery Europ J Obstet Gynec Reprod Biol 1984; 18: 149-153
• 13 Henny Ch P, ten Cate H, ten Cate JW, Prummel MF, Peters M, Biiller HR. Thrombosis prophylaxis in an AT III deficient pregnant woman: application of a low molecular weight heparinoid. Thromb Haemostas 1986; 55: 301
• 14 Brandt P. Observations during the treatment of antithrombin-III deficient women with heparin and antithrombin concentrate during pregnancy, parturition and abortion. Thromb Res 1981; 22: 15-24
• 15 Jespersen J. Termination of pregnancy in a woman with hereditary antithrombin deficiency under antithrombotic protection with subcutaneous heparin and infusion of plasma. Gynecol Obstet Invest 1981; 12: 267-271
• 16 Leone G, De Stefano V, Di Donfrancesco A, Ferrelli R, Traisci G, Bizzi B. Antithrombin III Pescara: a defective AT III variant with no alterations of plasma crossed Immunoelectrophoresis, but with an abnormal crossed immunoelectrofocusing pattern. Br J Haematol 1987; 65: 187-191
• 17 Leone G, Cotumaccio R, De Stefano V, Zanetti L. Antithrombin III Roma: a familial quantitative-qualitative AT III deficiency identifiable by crossed immunoelectrofocusing and by crossed immunoelec- trophoresis. Haematologica 1983; 68: 765-774
• 18 Leone G, Valori V M, Storti S, Myers T. Inferior vena cava thrombosis in a child with familial antithrombin III deficiency. Thromb Haemostas 1980; 43: 74
• 19 Allain JP, Verroust F, Soulier JP. In vitro and in vivo characterization of Factor VIII preparations. Vox Sang 1980; 38: 68-80
• 20 Hall JG, Pauli RM, Wilson KM. Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med 1980; 68: 122-140
• 21 Chen WW C, Chan CS, Lee PK, Wang RY C, Wong VC W. Pregnancy in patients with prosthetic heart valves: an experience with 45 pregnancies Q J Med. 1982; 51: 358-365
• 22 Chong MK B, Harvey D, De Swiet M. Follow-up study of children whose mothers were treated with warfarin during pregnancy. Br J Obstet Gynaecol 1984; 91: 1070-1073
• 23 Iturbe-Alessio I, Fonseca MD C, Mutchinik O, Santos MA, Zajarias A, Salazar E. Risks of anticoagulant therapy in pregnant women with artificial heart valves. N Engl J Med 1986; 315: 1390-1393
• 24 Mannucci PM, Boyer C, Wolf M, Tripodi A, Larrieu MJ. Treatment of congenital antithrombin III deficiency with concentrates. Br J Haematol 1982; 50: 531-535
• 25 Jespersen J, Rasmussen NR, Sidelmann J. Differences between functional and immunologic determinations of plasma antithrombin during the treatment of disseminated intravascular coagulation by infusion of antithrombin III concentrate. Acta Chir Scand 1982; 148 suppl. (Suppl. 509) 105-107
• 26 Tengborn L, Bengtsson T. Antithrombin III concentrate. Thromboprophylaxis during pregnancy in a patient with congenital antithrombin III deficiency Acta Obstet Gynecol Scand 1986; 65: 375-376
• 27 Barrowcliffe TW, Eggleton CA, Mahmoud M. Studies of the heterogeneity of antithrombin III concentrates. Br J Haematol 1983; 55: 37-46