Perioperative management of venous recanalization in a patient with inherited antithrombin deficiency: case report

• DOI: 10.1016/j.rpth.2024.102384
• Publication Date: 2024-03-15T04:42:18Z
• Authors: Julie Benzakine; Carla Rial; Nassim Mohamedi; Emmanuel Messas; Laetitia Mauge; Marc Sapoval; Nicolas Gendron; Lina Khider

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.