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Heparin Resistance due to an Acquired Antithrombin Deficiency in a Patient With Sickle Cell Disease During a Pregnancy Complicated by Bilateral Pulmonary Emboli

A Case Report

Wells, Ashley V., MD*; Zarkhin, Eli, MD*; Weiner, Menachem M., MD; Katz, Daniel, MD*

doi: 10.1213/XAA.0000000000000917
Case Reports

We report a 31-year-old woman with sickle beta thalassemia zero who presented at 21 weeks gestational age with multiple bilateral pulmonary emboli and no hemodynamic instability. Acquired antithrombin deficiency was suspected due to a refractory response to therapeutic anticoagulation with enoxaparin, unfractionated heparin, and fondaparinux, and a reduced antithrombin antigen level. At 26 4/7 weeks, she developed signs concerning for increased pulmonary clot burden. To avoid the use of alternative anticoagulants that may cross the placenta and impact the fetus, a planned cesarean delivery was performed without complication at 27 weeks gestation. Both mother and child experienced successful long-term outcomes.

From the *Department of Anesthesiology, Perioperative & Pain Medicine

Division of Cardiothoracic Anesthesia, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.

Accepted for publication September 17, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Ashley V. Wells, MD, Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mt Sinai Hospital, Box 1010, One Gustave L Levy Pl, New York, NY 10029. Address e-mail to

© 2019 International Anesthesia Research Society
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