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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Treatment of patients with antithrombin III (ATIII) deficiency depends on the clinical setting. Three congenital conditions are discussed: homozygous antithrombin III deficiency discovered in neonates, heterozygous antithrombin III deficiency in patients with their first thrombosis, and heterozygous antithrombin III deficiency in patients with previous thrombosis.

Antithrombin III deficiency may be congenital but may also be acquired. Antithrombin III replacement in patients with acquired antithrombin III deficiency is also addressed.

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.

Replacement of antithrombin in neonates with antithrombin III deficiency to treat lung disease has been studied and found to have no benefit. Antithrombin infusion in otherwise asymptomatic neonates found to be deficient is not recommended.

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