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Incidence in USA: 1:2000-5000 (may be higher)
Men and women equally affected and no racial or ethnic difference
Risk of postop thromboembolic phenomena; 40% to 70%, most common (in descending order): DVT, pulm embolus, mesenteric thrombosis, cerebral venous, and retinal thrombosis; highest risk in those with antithrombin III (AT III) levels <50% of normal
Risk of pregnancy-related venous thromboembolism may be >50% in untreated pts
Heparin resistance is common
Hypercoagulable state periop
Thrombus formation on indwelling cath
Pulm emboli or DVT with immobility
Mesenteric, inferior vena cava, or CNS thrombosis
Withdrawal of warfarin sodium preop, as pts may be heparin resistant
Timing of neuraxial anesthesia in anticoagulated pts
AT III is an α 2 -globulin and a serine protease inhibitor, capable of inactivation of thrombin and factor Xa in blood.
It has antiinflammatory properties via interactions with the endothelium.
AT III deficiency results in an unusual susceptibility to thromboembolic disease.
Heparin resistance may be problematic during surgery.
Massive thromboembolism can occur periop with AT III levels <50.
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