Neuraxial Anesthesia for Labor and Cesarean Delivery in a Parturient With Hereditary Antithrombin Deficiency on Recombinant Human Antithrombin Infusion Therapy

Pamnani, Anup; Rosenstein, Melissa G.; Darwich, Alaeldin A.; Wolfson, Allan B.

doi:10.1097/01.aoa.0000406705.33423.bc

Cited by 3 publications

(3 citation statements)

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“…Epidural placement for labour analgesia and subsequent caesarean section has been described in two case reports. Pamnani et al described the perioperative use of recombinant ATIII (Atryn, GTC Biotherapeutics [now rEVO Biologics], Framingham, MA, USA) and reported no complications in its use 7 . Rowbotham et al described epidural use with heparin prophylaxis, in the absence of ATIII replacement, without complication 8 .…”

Section: Discussionmentioning

confidence: 99%

Hereditary Antithrombin III Deficiency and Neuraxial Anaesthesia

Piper

Farrell

2015

Anaesth Intensive Care

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Antithrombin III (ATIII) deficiency offers unique challenges to the anaesthetist in the perioperative setting due to the inherent thrombophilia, the anticoagulant therapies instituted and replacement of the deficient intrinsic natural anticoagulant. A particular challenge is the use of intrathecal anaesthesia, which requires a safe level of coagulation at the time of subarachnoid puncture. We describe the use of intrathecal anaesthesia on two occasions in a patient with ATIII deficiency who received human-derived ATIII concentrate as part of a perioperative anticoagulant regimen. The patient sustained no thrombotic or bleeding events. Our experience suggests that ATIII deficiency does not preclude the use of regional anaesthetic techniques so long as there is timely referral to a multidisciplinary perioperative service for anticoagulant management and that ATIII concentrate is used to ensure safe levels of ATIII throughout the perioperative period.

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Section: Discussionmentioning

confidence: 99%

Hereditary Antithrombin III Deficiency and Neuraxial Anaesthesia

Piper

Farrell

2015

Anaesth Intensive Care

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“…Hellegren et al [ 3 ] maintained patients on antithrombin III intravenous infusion during labor and delivery to maintain the activity level > 80%. Pamnani et al [ 8 ] documented the safety of neuraxial anesthesia in one patient using this medication, after discontinuation of her low molecular weight heparin for 24 h. Neonates of mothers receiving antithrombin III infusions had antithrombin III activity that was normal for their gestational age, with a mean of 57%, comparable to the 60% levels noted in healthy newborns [ 3 ]. Maternal treatment was typically continued in these reports for 4 days to 2 weeks postpartum, unlike our patient in whom we discontinued the antithrombin III when she achieved full anticoagulation on enoxaparin, without any complications [ 1 , 3 , 6 , 8 ].…”

Section: Commentmentioning

confidence: 99%

The intrapartum use of antithrombin III in an antithrombin III-deficient patient: a case report and review of the literature

Lal

Hibbard

2013

Case Reports in Perinatal Medicine

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Background: Antithrombin III deficiency is an inherited thrombophilia that places pregnant patients at an increased risk of venous thromboembolism and adverse outcomes in pregnancy. Antithrombin III-deficient patients undergoing obstetric procedures may benefit from antithrombin III infusions during labor and delivery. Case: The patient is a 32-year-old G2P1000 with known antithrombin III deficiency and factor V Leiden heterozygosity with a prior intrauterine fetal demise. The patient was managed with therapeutic enoxaparin until 37 weeks ' gestation when she was changed to IV heparin and plasma-derived antithrombin III. She underwent successful induction of labor, epidural anesthesia, and had an uncomplicated vaginal delivery. Conclusion: Plasma-derived antithrombin III can be used intrapartum for successful delivery in a patient with antithrombin III deficiency.

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“…cesarean section, elective surgery and delivery) (Tiede et al, 2008). There are a limited number of case reports stating successful administration of epidural anesthesia and www.intechopen.com analgesia under an antithrombin treatment in hereditary antithrombin deficiency (Pamnani et al, 2010).…”

Section: Antithrombin III Deficiencymentioning

confidence: 99%