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  • Title: Observations during the treatment of antithrombin-III deficient women with heparin and antithrombin concentrate during pregnancy, parturition, and abortion.
    Author: Brandt P.
    Journal: Thromb Res; ; 22(1-2):15-24. PubMed ID: 7292437.
    Abstract:
    Pregnancy and delivery increase the risk of thrombosis in women with HAD (hereditary antithrombin deficiency). This report describes the combined use of subcutaneous heparin and antithrombin concentrate in 2 pregnant women aged 27 and 19 with a family history of HAD in whom thrombosis, with few exceptions, is associated with estrogen exposure, pregnancy, and delivery. Venous blood samples were collected without stasis by Venoject siliconized needles. Platelet rich plasma (PRP) and platelet poor plasma (PPP) were prepared by centrifugation. Coagulation times by recalcification of plasma were determined, and antithrombin 3 (AT-3) assayed in the presence of heparin in PPP by the method of Odengaard et.al. In the 27-year old patient, treatment with subcutaneous heparin (5000 U twice daily) began 3 weeks prior to anticipated delivery. At expected term and 30 minutes prior to initiation of oxytocin drip, 550 units of AT-3 concentrate was infused. AT-3 infusion was subsequently increased, and subcutaneous heparin was increased to 10,000 U twice daily. At spontaneous labor 3 days later, platelet aggregates appeared, counts and AT-3 levels dropped, and clotting times became shorter. Following infusion of AT-3 concentrate, platelet aggregates disappeared, clotting times increased, and platelet counts and AT-3 levels returned to their normal values. The patient delivered uneventfully with no abnormal bleeding. 4 days later, she had several periods of low levels of AT-3, which were later corrected by the infusion of AT-3. The 19-year old patient undergoing abortion was given intravenous heparin (10,000 U every 6 hours) following admission for the next 36 hours. The treatment was changed to subcutaneous heparin (10,000 U twice daily) because of very low platelet count, and an AT-3 levels fluctuated. Therapy with AT-3 concentrate and subcutaneous heparin was continued until platelet counts, clotting times, and AT-3 levels returned to normal. The study shows the value of subcutaneous heparin in treating pregnant women with HAD. It also shows the complex nature of heparin and antithrombin.
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