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Antithrombin Deficiency

By Joel L. Moake, MD

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Because antithrombin inhibits thrombin and factors Xa, IXa, and XIa, deficiency of antithrombin predisposes to venous thrombosis.

Antithrombin is a protein that inhibits thrombin and factors Xa, IXa, and XIa, thereby inhibiting thrombosis (see Overview of Thrombotic Disorders).

Heterozygous deficiency of plasma antithrombin has a prevalence of about 0.2 to 0.4%; about half of people affected develop venous thromboses. Homozygous deficiency is probably lethal to the fetus in utero.

Acquired deficiencies occur in patients with disseminated intravascular coagulation, liver disease, or nephrotic syndrome or during heparin therapy. Heparin exerts its anticoagulant effect by activating antithrombin.

Laboratory testing is done for patients with an unexplained blood clot and involves quantification of plasma inhibition of thrombin in the presence of heparin.


  • Warfarin to prevent venous thromboembolism

Oral warfarin is used for prophylaxis against venous thromboembolism. It is not known whether the newer oral anticoagulants that inhibit either thrombin (dabigatran) or factor Xa (eg, rivaroxaban, apixaban) can be used in place of warfarin in this disorder.

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