Antithrombin III deficiency as a reflection of dynamic protein metabolism in patients undergoing vascular reconstruction

W. R. Flinn, M. D. McDaniel, J. S. Yao, V. A. Fahey, D. Green

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39 Scopus citations


Antithrombin III (AT-III) deficiency has been associated with increased risk of venous and arterial thromboses and arterial graft failure. Deficiency of this circulating glycoprotein may be congenital; however, acquired deficiencies may develop in protein-losing or protein-wasting states. In the present study, AT-III levels of 108 patients undergoing vascular surgical procedures were determined preoperatively and at intervals (third, fifth, and seventh days) postoperatively. The mean AT-III level was then compared to the patient's protein status. The effect of reduced AT-III activity on early graft failure was also noted. A low preoperative AT-III level (<80%) was found in 16.3% of the patients studied. Among 83 patients with serum albumin levels >3.0 gm/dl or transferrin levels >180 mg/dl, reduced AT-III activity was present in only 10 (12%). In contrast, when serum albumin levels were <3.0 gm/dl, AT-III deficiency was found in 12 of 25 patients (48%) (p < 0.01). Early thrombosis of a femorodistal graft occurred in 5 of 15 patients (33%) with reduced AT-III levels. When AT-III levels were normal, early bypass failure occurred in only 9 of 67 grafts (13.4%). However, this difference was not statistically significant. An additional 15 patients had sequential pre- and postoperative measurements (up to 3 weeks) of serum protein and AT-III levels to illustrate the relationship between the dynamics of protein metabolism and AT-III levels. There was a clear temporal relationship between albumin, transferrin, and AT-III levels. Following nutritional support, an increase in albumin was followed by a corresponding normalization of the AT-III level. The development of AT-III deficiency from sustained protein catabolism may result in a hypercoagulable state similar to that in the nephrotic syndrome. Recognition and reversal of this deficiency may reduce the likelihood of early graft failure in some patients.

Original languageEnglish (US)
Pages (from-to)888-895
Number of pages8
JournalJournal of Vascular Surgery
Issue number6
StatePublished - Nov 1984

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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