Management of antithrombin III deficiency in pregnancy: a representative case and a literature review
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.230
Abstract
The work is aimed at discussing pregnancy management for the most thrombogenic genetic thrombophilia - antithrombin III (AT-III) deficiency. A detailed analysis of the literature and clinical case of pregnancy management in a patient with AT-III deficiency, pulmonary embolism and habitual history of miscarriage has been performed and presented. Patients with AT-III deficiency are at high risk for developing thrombotic and obstetric complications even despite using therapeutic doses of anticoagulants. Indications for use and modes of administration of AT-III concentrate have not been currently defined clearly. Monitoring therapy with low molecular weight heparin is largely complicated because a test for determining anti-Xa activity is AT-III-dependent. In addition to standard methods for controlling antithrombotic therapy, we used tests characterizing the dynamic blood clot parameters: thromboelastography and thrombin generation test. The peak risk resulting in both thrombotic and hemorrhagic complications in such patients occurs during period of labor and the postpartum period, when a change in the regimen of anticoagulant therapy is required with its temporary withdrawal and additional administration of AT-III concentrate.
About the Authors
S. V. Akinshina
«Medical Centre for Women» LLC
Russian Federation
Russian Federation
Svetlana V. Akinshina - MD, PhD, Obstetrician-Gynecologist, Hematologist, «Medical Centre for Women» LLC.
62 Str. Zemlyanoi Val, Moscow 109004.
P. K. Genina
Sechenov University
Russian Federation
Russian Federation
Polina K. Genina - 6th year Student, Department of General Medicine, Sechenov University.
2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991.
V. O. Bitsadze
Sechenov University
Russian Federation
Russian Federation
Victoria O. Bitsadze - MD, Dr Sci Med, Professor of RAS, Professor, Department of Obstetrics and Gynecology, Filatov Clinical Institute of Children's Health, Sechenov University.
2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991.
Scopus Author ID: 6506003478.
Researcher ID: F-8409-2017.
J. Kh. Khizroeva
Sechenov University
Russian Federation
Russian Federation
Jamilya Kh. Khizroeva - MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology, Filatov Clinical Institute of Children's Health, Sechenov University.
2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991.
Scopus Author ID: 57194547147.
Researcher ID: F-8384-2017.
V. I. Tsibizova
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Valentina I. Tsibizova - MD, PhD, Obstetrician-Gynecologist, Research Laboratory of Operative Gynecology, Institute of Perinatology and Pediatrics; Physician, Department of Functional and Ultrasound Diagnostics, Almazov National Medical Research Centre.
2 Akkuratova Str., Saint Petersburg 197341.
A. D. Makatsariya
Sechenov University
Russian Federation
Russian Federation
Alexander D. Makatsariya - MD, Dr Sci Med, Professor, Academician of RAS, Head of the Department of Obstetrics and Gynecology, Filatov Clinical Institute of Children's Health, Sechenov University.
2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991.
Scopus Author ID: 57222220144.
Researcher ID: M-5660-2016.
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Review
For citations:
Akinshina S.V., Genina P.K., Bitsadze V.O., Khizroeva J.Kh., Tsibizova V.I., Makatsariya A.D. Management of antithrombin III deficiency in pregnancy: a representative case and a literature review. Obstetrics, Gynecology and Reproduction. 2021;15(4):441-450. https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.230
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