How is antithrombin III (ATIII) deficiency treated?

Updated: Mar 04, 2020
  • Author: James L Harper, MD; Chief Editor: Hassan M Yaish, MD  more...
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In neonates who have AT3 homozygous mutations, arterial and venous thrombosis are seen, particularly if vascularly invasive procedures (eg, extracorporeal membrane oxygenation [ECMO], umbilical vessel catheterization) are performed. In these patients, replacement of antithrombin III using antithrombin III concentrates or fresh frozen plasma is recommended.

Enoxaparin (Lovenox), a low–molecular-weight heparin (LMWH), is frequently used to prevent thrombi, as well as to prevent the propagation of thrombi that have already occurred. In antithrombin III deficiency, however, the activity of LMWH is not as reliable as in an otherwise healthy person.

Once a patient with congenital antithrombin III deficiency has developed thrombosis, anticoagulation is more strongly indicated. Warfarin (Coumadin) is the principal anticoagulant used. This vitamin K antagonist is administered at a dose to maintain an international normal ratio (INR) on PT of 1.5-2.5.

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