title: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  She recovered from the operation uneventfully, and wad discharged in the 12(th) postoperative day. In the 6(th) 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.
authors.affiliation: Preventive Cardiovascular Research Centre Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran.
authors.forename: Feridoun
authors.initials: F
authors.lastname: Sabzi
authors.affiliation: Department of Gynecology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Donya
authors.initials: D
authors.lastname: Khosravi
authors.affiliation: Preventive Cardiovascular Research Centre Kermanshah, Kermanshah University of Medical Sciences, Kermanshah, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Faraji
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D000990:Antithrombin III / Q000378:metabolism*; D020152:Antithrombin III Deficiency / Q000150:complications* / Q000188:drug therapy; D000991:Antithrombins / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D005260:Female; D006325:Heart Atria / Q000473:pathology* / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011262:Pregnancy Trimester, Second; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology*; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D014859:Warfarin; D000990:Antithrombin III
keywords: antithrombin; cardiac surgery; deficiency; pregnancy