Antithrombin Deficiency in Trauma and Surgical Critical Care

J Surg Res. 2020 Dec:256:536-542. doi: 10.1016/j.jss.2020.07.010. Epub 2020 Aug 13.

Abstract

Antithrombin deficiency (ATD) was described in 1965 by Olav Egeberg as the first known inherited form of thrombophilia. Today, it is understood that ATDs can be congenital or acquired, leading to qualitative, quantitative, or mixed abnormalities in antithrombin (AT). All ATDs ultimately hinder AT's ability to serve as an endogenous anticoagulant and antiinflammatory agent. As a result, ATD patients possess higher risk for thromboembolism and can develop recurrent venous and arterial thromboses. Because heparin relies on AT to augment its physiologic function, patients with ATD often exhibit profound heparin resistance. Although rare as a genetic disorder, acquired forms of ATD are seen with surprising frequency in critically ill patients. This review discusses ATD in the context of surgical critical care with specific relevance to trauma, thermal burns, cardiothoracic surgery, and sepsis.

Keywords: Antithrombin deficiency; Arterial thrombosis; Surgical critical care; Thrombophilia; Trauma.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants / administration & dosage*
  • Antithrombin III / genetics
  • Antithrombin III Deficiency / complications*
  • Antithrombin III Deficiency / diagnosis
  • Antithrombin III Deficiency / drug therapy
  • Antithrombin III Deficiency / genetics
  • Antithrombins / administration & dosage
  • Antithrombins / metabolism
  • Critical Care
  • Critical Illness
  • Heparin / metabolism
  • Humans
  • Mutation
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Recombinant Proteins / administration & dosage
  • Sepsis / blood
  • Sepsis / complications
  • Sepsis / surgery
  • Surgical Procedures, Operative / adverse effects*
  • Thrombomodulin / administration & dosage
  • Thrombosis / etiology
  • Thrombosis / prevention & control*
  • Wounds and Injuries / blood
  • Wounds and Injuries / complications
  • Wounds and Injuries / surgery

Substances

  • Anticoagulants
  • Antithrombins
  • Recombinant Proteins
  • SERPINC1 protein, human
  • THBD protein, human
  • Thrombomodulin
  • Antithrombin III
  • Heparin