[Prevention of the thromboembolic risk during the operative period in a patient with a congenital antithrombin III deficiency].

The case of a woman with congenital antithrombin III (AT III) deficiency undergoing elective hysterectomy is reported. AT III deficient patients have high risks of thromboembolic disease, especially developing during and after surgery. It is usual practice to discontinue oral anticoagulants with antivitamin K activity and to obtain effective AT III activity by the transfusion of freeze-dried concentrates of AT III and/or fresh frozen plasma (FFP). Heparin is prescribed as soon as AT III activity reaches 70%. The oral anticoagulant regimen is reinstituted in the late postoperative period. In our case, transfusion of FFP, in the pre- and postoperative periods, results in an AT III activity of 63%. Heparin was not used because oral anticoagulants were readministered early, 12 h after operation. No clinical thrombo-embolic complication was observed.