Management of Venous Thromboembolism in Patients with Hereditary Antithrombin Deficiency and Pregnancy: Case Report and Review of the Literature

Table 2

AT concentrate for treatment of VTE in patients with hereditary AT deficiency and pregnancy.

Study	Study design	Case	Thrombotic condition	Previous anticoagulation	AT Peripartum prophylaxis	Type and dosage of AT used	Concurrent anticoagulation	AT concentrate initiation/duration	Goal of AT levels	Outcome
Ilonczai et al. 2015	Retrospective	Pt1	Bilateral DVT at gw 7	Yes	No	N/A	Therapeutic dose LMWH	VTE event to miscarriage	80–120%	Miscarriage at gw8
		Pt2	PE at gw 7	Yes	50 IU × 2 days	2500 3tw		VTE event to delivery		Healthy M and N
Rogenhofer et al. (2014)	Retrospective	Pt1G1	DVT Lt arm at gw 12	Yes	N/A	1500 3tw	Weight adjusted prophylactic dosage LMWH	VTE event to delivery	N/A	Healthy M and N
		Pt1G2	Sinus thrombosis gw 11			1500 Q3D				Healthy M and N
Bramham et al. (2013)	Retrospective	Pt1	Sinus thrombosis gw 11	No; (new Dx)	50 IU/Kg	3000 IU alternate days	Therapeutic UFH infusion	VTE event to delivery	>80%	Healthy M and N
		Pt2	Sinus thrombosis gw 9	Yes	50 IU/Kg	3000 IU alternate days		N/A		Healthy M and N
		Pt3	DVT at 28 gw	Yes	50 IU/Kg	2000 IU OD × 3 days after IVC filter insertion		3 days after IVC filter insertion		M:PE after IVC filter insertion.; N: required NICU
James et al. (2013)	Prospective	Pt1	DVT, PE at gw 20	No; (new Dx)	N/A	Plasma-derived AT concentrate (Thrombate III); Loading dose (in units) = ( normal) × wt in kg/1.4; Maintenance dose = 60% of loading dose	Therapeutic UFH	Prior delivery to 6 days postpartum	After LD, 80%; Maintenance dose, 70–120%	Healthy M and N
		Pt2	DVT early in pregnancy	Yes				Preeclampsia early labor		Healthy M and N
		Pt3	DVT left leg at gw 8	Yes				VTE event to delivery		Healthy M and N
		Pt4	PE at gw 12	Yes				VTE event to delivery		Healthy M and N
		Pt5	DVT at gw 9	Yes				VTE to abortion		Therapeutic abortion
		Pt6	PE at gw 12	Yes				VTE to abortion		Therapeutic abortion
Tanimura et al. (2012)	Case report	Pt1	DVT at gw7, HIT	No; (new Dx)	1500 IU for 2 days	3000 IU loading then 1500 IU 2tw	UFH then switch to argatroban	VTE event to delivery	>70%	Healthy M and N
Sharpe et al. (2011)	Case report	Pt1	SVT at gw 34	Yes	3000 IU for 3 days	Plasma-derived AT concentrate: 3000 daily for 5 days then alternate 2000 IU and 3000 IU continued for 6 weeks postpartum	UFH IV	VTE event to delivery	100%	Healthy M and N
Hidaka et al. (2008)	Case report	Pt1	LE DVT at gw 24	No	3000 IU for 1 day	3000 IU 2-3x per week	UFH IV + IVC filter	VTE event to delivery	>70%	M: progression of DVT & developed PE
Alguel et al. (2007)	Case report	Pt1	Pathological flow in umbilical artery at gw 35	Yes	2000 IU for 7 days	6000 IU × 1 dose; 2000 IU × 6 days postpartum	Therapeutic LMWH	VTE event to 6 days postpartum	>70%	Healthy M and N
Shiozaki et al. (1993)	Case report	Pt1	DVT in early pregnancy, recurrence at gw 37	Yes	2000 IU × 1 day	2000 IU first dose, then 1000 IU once weekly	Therapeutic LMWH	Gw 37 to 9 days postpartum	>80%	Healthy M and N
Kario et al. (1992)	Case report	Pt1	DVT at gw 6	Yes	3000 IU × 1 day	Not indicated	UFH IV	Gw 6, not indicated; Restarted Gw 34–40 (2° prophylaxis)	>80%	Healthy M and N
Menache et al. (1990)	PROBE	Pt1	DVT at gw 10	Yes	Yes	Plasma-derived AT-III concentrate; Total 14,563 IU for 5 d; Total 17,355 IU for 7 d	UFH IV	Gw 10-11 & postpartum (5 days)	80–120%	Healthy M and N
		Pt2	DVT at gw 14	Yes	No			GW 14-15 without postpartum prophylaxis		M: developed Pelvic and vena cava DVT 4.5 weeks after delivery
Hellgren et al. (1982)	Case series	Pt1	DVT at gw 13	Yes	N/A	Plasma-derived AT-III concentrate; Total 28500 IU for 10 d; Total 7500 IU for 4 d; 8000 IU for 1 dose	UFH IV	Gw 13, abortion	80–120%	Therapeutic abortion
		Pt2	DVT at gw 6					Gw 6, miscarriage		Miscarriage
		Pt3	DVT early in pregnancy					A single dose		Therapeutic abortion

AT: antithrombin, DVT: deep vein thrombosis, Dx: diagnosis, gw: gestational week, HIT: heparin-induced thrombocytopenia, IU: international units, IVC: inferior vena cava, LE: lower extremity, LMWH: low molecular weight heparin, M: mother, N/A: not available or not specified, N: newborn, OD: daily, PE: pulmonary embolus, PROBE: prospective randomized open blinded end-point, Pt: patient, Q3D: every 3 days, UFH: unfractionated heparin, wt: weight, 2tw: two times per week, and 3tw: three times per week.