Congenital Antithrombin Deficiency in a Pregnant Woman with Right Atrium Thrombosis

Abstract

BACKGROUND: One of the rare causes of venous thromboembolism in pregnancy is antithrombin III deficiency. Antithrombin III deficiency is estimated to carry a 30% risk of venous thrombotic  complication during each pregnancy and postpartum.
CASE DETAILS: We present thea case of a A 21-year-old pregnant woman (Para 1+) with a history of  large atrial septal defect repair at our hospital (Imam Ali Hospital, 2 May 2014). The patient, with  unknown history of antithrombin III deficiency, was admitted at our emergency center with dyspnea and chest pain for the rule out of tamponade. She presented with a right atrial thrombosis in the second  trimester of pregnancy despite the use of therapeutic doses of heparin and warfarin in the postoperative  period as thromboembolic prophylaxis. The risk of warfarin emberyopaty led to termination of pregnancy, and successful redo-cardiac surgery outcome was achieved with the combined use of therapeutic  anticoagulation and regular plasma-derived antithrombin concentrate infusions to normalize her  antithrombin levels.
CONCLUSSION: She recovered from the operation uneventfully, and wad discharged in the 12th postoperative day. In the 6th month of follow-up, antithrombin III increased to 70% in more stable level  and transethoracic echocardiography showed no recurrence of right atrial thrombus formation. This case  leads to further debate regarding whether full anticoagulation should be a worthy preventive measure for  venous thromboembolic prophylaxis after an open heart surgery complicated by pregnancy in a women  with inherited antithrombin III deficiency. This point may become more relevant as further experience is  gained with the use of recombinant human antithrombin in known cases during open cardiac surgery.

KEYWORDS: pregnancy, antithrombin ш deficiency, cardiac surgery