Antithrombin III deficiency as a reflection of dynamic protein metabolism in patients undergoing vascular reconstruction.
Antithrombin III (AT-III) deficiency has been associated with increased risk of venous and arterial thromboses and arterial graft failure. Deficiency of this circulating glycoprotein may be congenital; however, acquired deficiencies may develop in protein-losing or protein-wasting states. In the present study, AT-III levels of 108 patients undergoing vascular surgical procedures were determined preoperatively and at intervals (third, fifth, and seventh days) postoperatively. The mean AT-III level was then compared to the patient's protein status. The effect of reduced AT-III activity on early graft failure was also noted. A low preoperative AT-III level (less than 80%) was found in 16.3% of the patients studied. Among 83 patients with serum albumin levels greater than 3.0 gm/dl or transferrin levels greater than 180 mg/dl, reduced AT-III activity was present in only 10 (12%). In contrast, when serum albumin levels were less than 3.0 gm/dl, AT-III deficiency was found in 12 of 25 patients (48%) (p less than 0.01). Early thrombosis of a femorodistal graft occurred in 5 of 15 patients (33%) with reduced AT-III levels. When AT-III levels were normal, early bypass failure occurred in only 9 of 67 grafts (13.4%). However, this difference was not statistically significant. An additional 15 patients had sequential pre- and postoperative measurements (up to 3 weeks) of serum protein and AT-III levels to illustrate the relationship between the dynamics of protein metabolism and AT-III levels. There was a clear temporal relationship between albumin, transferrin, and AT-III levels.(ABSTRACT TRUNCATED AT 250 WORDS)
D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D020152:Antithrombin III Deficiency; D001798:Blood Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D009747:Nutritional Physiological Phenomena; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D012306:Risk; D012709:Serum Albumin / Q000032:analysis; D013927:Thrombosis / Q000453:epidemiology; D014168:Transferrin / Q000032:analysis; D014656:Vascular Surgical Procedures
D001798:Blood Proteins; D012709:Serum Albumin; D014168:Transferrin; D000990:Antithrombin III