Table 2.
AT concentrate for treatment of VTE in patients with hereditary AT deficiency and pregnancy.
| Study | Study design | Case | Thrombotic condition | Previous anticoagulation | AT Peripartum prophylaxis | Type and dosage of AT used | Concurrent anticoagulation | AT concentrate initiation/duration | Goal of AT levels | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|
| Ilonczai et al. 2015 | Retrospective | Pt1 | Bilateral DVT at gw 7 | Yes | No | N/A | Therapeutic dose LMWH | VTE event to miscarriage | 80–120% | Miscarriage at gw8 |
| Pt2 | PE at gw 7 | Yes | 50 IU × 2 days | 2500 3tw | VTE event to delivery | Healthy M and N | ||||
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| Rogenhofer et al. (2014) | Retrospective | Pt1G1 | DVT Lt arm at gw 12 | Yes | N/A | 1500 3tw | Weight adjusted prophylactic dosage LMWH | VTE event to delivery | N/A | Healthy M and N |
| Pt1G2 | Sinus thrombosis gw 11 | 1500 Q3D | Healthy M and N | |||||||
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| Bramham et al. (2013) | Retrospective | Pt1 | Sinus thrombosis gw 11 | No (new Dx) |
50 IU/Kg | 3000 IU alternate days | Therapeutic UFH infusion | VTE event to delivery | >80% | Healthy M and N |
| Pt2 | Sinus thrombosis gw 9 | Yes | 50 IU/Kg | 3000 IU alternate days | N/A | Healthy M and N | ||||
| Pt3 | DVT at 28 gw | Yes | 50 IU/Kg | 2000 IU OD × 3 days after IVC filter insertion | 3 days after IVC filter insertion | M:PE after IVC filter insertion. N: required NICU |
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| James et al. (2013) | Prospective | Pt1 | DVT, PE at gw 20 | No (new Dx) |
N/A | Plasma-derived AT concentrate (Thrombate III) Loading dose (in units) = (120% − basal% normal) × wt in kg/1.4 Maintenance dose = 60% of loading dose |
Therapeutic UFH | Prior delivery to 6 days postpartum | After LD, 80% Maintenance dose, 70–120% |
Healthy M and N |
| Pt2 | DVT early in pregnancy | Yes | Preeclampsia early labor | Healthy M and N | ||||||
| Pt3 | DVT left leg at gw 8 | Yes | VTE event to delivery | Healthy M and N | ||||||
| Pt4 | PE at gw 12 | Yes | VTE event to delivery | Healthy M and N | ||||||
| Pt5 | DVT at gw 9 | Yes | VTE to abortion | Therapeutic abortion | ||||||
| Pt6 | PE at gw 12 | Yes | VTE to abortion | Therapeutic abortion | ||||||
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| Tanimura et al. (2012) | Case report | Pt1 | DVT at gw7, HIT | No (new Dx) |
1500 IU for 2 days | 3000 IU loading then 1500 IU 2tw | UFH then switch to argatroban | VTE event to delivery | >70% | Healthy M and N |
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| Sharpe et al. (2011) | Case report | Pt1 | SVT at gw 34 | Yes | 3000 IU for 3 days | Plasma-derived AT concentrate: 3000 daily for 5 days then alternate 2000 IU and 3000 IU continued for 6 weeks postpartum | UFH IV | VTE event to delivery | 100% | Healthy M and N |
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| Hidaka et al. (2008) | Case report | Pt1 | LE DVT at gw 24 | No | 3000 IU for 1 day | 3000 IU 2-3x per week | UFH IV + IVC filter | VTE event to delivery | >70% | M: progression of DVT & developed PE |
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| Alguel et al. (2007) | Case report | Pt1 | Pathological flow in umbilical artery at gw 35 | Yes | 2000 IU for 7 days | 6000 IU × 1 dose 2000 IU × 6 days postpartum |
Therapeutic LMWH | VTE event to 6 days postpartum | >70% | Healthy M and N |
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| Shiozaki et al. (1993) | Case report | Pt1 | DVT in early pregnancy, recurrence at gw 37 | Yes | 2000 IU × 1 day | 2000 IU first dose, then 1000 IU once weekly | Therapeutic LMWH | Gw 37 to 9 days postpartum | >80% | Healthy M and N |
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| Kario et al. (1992) | Case report | Pt1 | DVT at gw 6 | Yes | 3000 IU × 1 day | Not indicated | UFH IV | Gw 6, not indicated Restarted Gw 34–40 (2° prophylaxis) |
>80% | Healthy M and N |
|
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| Menache et al. (1990) | PROBE | Pt1 | DVT at gw 10 | Yes | Yes | Plasma-derived AT-III concentrate Total 14,563 IU for 5 d Total 17,355 IU for 7 d |
UFH IV | Gw 10-11 & postpartum (5 days) | 80–120% | Healthy M and N |
| Pt2 | DVT at gw 14 | Yes | No | GW 14-15 without postpartum prophylaxis | M: developed Pelvic and vena cava DVT 4.5 weeks after delivery | |||||
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| Hellgren et al. (1982) | Case series | Pt1 | DVT at gw 13 | Yes | N/A | Plasma-derived AT-III concentrate Total 28500 IU for 10 d Total 7500 IU for 4 d 8000 IU for 1 dose |
UFH IV | Gw 13, abortion | 80–120% | Therapeutic abortion |
| Pt2 | DVT at gw 6 | Gw 6, miscarriage | Miscarriage | |||||||
| Pt3 | DVT early in pregnancy | A single dose | Therapeutic abortion | |||||||
AT: antithrombin, DVT: deep vein thrombosis, Dx: diagnosis, gw: gestational week, HIT: heparin-induced thrombocytopenia, IU: international units, IVC: inferior vena cava, LE: lower extremity, LMWH: low molecular weight heparin, M: mother, N/A: not available or not specified, N: newborn, OD: daily, PE: pulmonary embolus, PROBE: prospective randomized open blinded end-point, Pt: patient, Q3D: every 3 days, UFH: unfractionated heparin, wt: weight, 2tw: two times per week, and 3tw: three times per week.