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General Medicine

Antithrombin Deficiency

Patrick T. Murray, MD and Holly L. Baab, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Antithrombin is a glycoprotein that inhibits thrombin by forming an irreversible complex.

  • There are two active sites: one that binds to heparin and one that binds to thrombin/target e...

DIAGNOSIS

HISTORY

  • Previous thrombosis

  • Family history of thrombosis

  • Family history of antithrombin deficiency

  • Recurrent pregnancy loss

PHYSICAL EXAM

Signs consistent with a deep or superficial venous thrombo...

TREATMENT

GENERAL MEASURES

Routine anticoagulation for asymptomatic patients with antithrombin deficiency is not recommended (3,4)[C]. 

MEDICATION

First Line

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Warfarin use requires periodic INR measurements (monthly after initial stabilization) with a goal of 2 to 3. 

DIET

Foods high in vitamin K may int...

REFERENCES

1
Lipe B, Ornstein DL. Deficiencies of natural anticoagulants, protein C, protein S, and antithrombin. Circulation.  2011;124(14):e365–e368. [View Abstract on OvidMedline]
2
Maclean PS, T...

ADDITIONAL READING

  • De Stefano V, Rossi E. Testing for inherited thrombophilia and consequences for antithrombotic prophylaxis in patients with venous thromboembolism and their relatives. A review of t...

SEE ALSO

Deep Vein Thrombophlebitis 

CODES

ICD10

D68.59 Other primary thrombophilia 

ICD9

  • 289.81 Primary hypercoagulable state

SNOMED

CLINICAL PEARLS

  • Antithrombin levels will be low on heparin and during acute thrombosis.

  • Diagnosis can be difficult. Conditions causing low levels of antithrombin III, such as pregnancy, liver disease, ...

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Related Images
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Figure 16-55 IVC UMBRELLA FILTER. A. AP Lumbar. B. Lateral Lumbar. This metallic umbrella fillter is placed in the inferior vena cava to capture emboli from the lower extremities in patients with thrombophlebitis.
Figure 16-55 IVC UMBRELLA FILTER. A. AP Lumbar. B. Lateral Lumbar. This metallic umbrella fillter is placed in the inferior vena cava to ca...
Figure 18-110DEEP VENOUS THROMBOSIS. A. Ultrasound,Lower Limb.Note the thrombus within the femoral vein (arrows). Failure of the vein to collapse from the compression of the ultra sound head confirms the presence of endoluminal thrombus (arrowheads). B. Pulmonary Embolism,Pulmonary CT Angiogram, Axial Chest.Observe the emboliin the pulmonary artery (arrow) and left atrium (arrow). COMMENT:Lower limb ultrasound evaluation is routinely p...
Figure 18-110DEEP VENOUS THROMBOSIS. A. Ultrasound,Lower Limb.Note the thrombus within the femoral vein (arrows). Failure of the vein to co...
FIGURE 24-15 Common sites of venous thrombosis. (A) Superficial thrombophlebitis. (B) Most common form of deep thrombophlebitis. (C and D) Deep thrombophlebitis from the calf to iliac veins.
FIGURE 24-15 Common sites of venous thrombosis. (A) Superficial thrombophlebitis. (B) Most common form of deep thrombophlebitis. (C and D) ...
Figure 13.28. Measurement of the lower extremity circumference. Increase in size is consistent with swelling, which might be due to a deep venous thrombosis.
Figure 13.28. Measurement of the lower extremity circumference. Increase in size is consistent with swelling, which might be due to a deep ...
Schematic of development of thrombus in deep vein
Schematic of development of thrombus in deep vein
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