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