The Administration of Antithrombin III in the Management of Severe Preeclampsia

Abstract

In severe preeclampsia/eclampsia a disseminated intravascular coagulation (DIC)-like syndrome is a prominent feature. Low levels of antithrombin III (AT-III; heparin cofactor) have been described in this syndrome. The objective of this pilot study is to determine whether the low levels of AT-III can be increased to normal by the intravenous administration of purified, concentrated, human AT-III. All patients entered into the study manifested thrombocytopenia, hemolytic anemia, coagulopathy, evidence of liver disease, and/or a bleeding diathesis. Each patient received a dose of AT-III equivalent to the amount in 3,000 ml of plasma. The levels of AT-III as measured by a functional assay were significantly increased (1.5–2x) following the initial 3,000 unit bolus of AT-III and prior to any other blood replacement therapy. The response of individual patients is proportional to the initial level of AT-III. In the control group there was no difference between the predelivery levels of AT-III and those obtained 12–24 hr postpartum. Therefore, the intravenous administration of AT-III may be useful in the treatment of patients with severe preeclampsia or eclampsia.

Key Words:

• Disseminated intravascular coagulation
• Heparin cofactor
• HELLP syndrome