A Case of Stasis Skin Ulcer due to Congenital Antithrombin III Deficiency

Abstract

Congenital antithrombin III deficiency is an inherited disorder associated with a tendency toward thrombosis. As laboratory findings are not always correlated with the clinical severity, there is no standardized approach for the treatment of leg ulcers, which are often associated with disease or perioperative anticoagulation management. We herein report the case of a patient with congenital antithrombin III deficiency with a stasis skin ulcer on the leg that was refractory to conservative treatment due to repeated episodes of cellulitis, who underwent segmental skin grafting and treatment with a combination of heparin and congenital antithrombin. The patient had an uncomplicated and satisfactory outcome, with no graft loss due to thrombosis or perioperative bleeding. Perioperative anticoagulation management of leg ulcers due to congenital antithrombin III deficiency has not been reported previously. We believe that appropriate perioperative management with anticoagulants is necessary for patients with chronic leg ulcers, considering the high rate of comorbidity of this disease. The strict management of this case resulted in successful treatment; however, the extent to which management is required requires further investigation.

Warfarin, AT3, and heparin administration and changes in APTT, AT3, and PT-INR over time: AT3 activity increased after its administration, with the target level reached on day 3, and remained constant thereafter.

Warfarin was resumed after complete withdrawal of bed rest following skin tie-off. On the seventh day of resumption, after the PT-INR reached > 2, both AT3 and heparin were discontinued. AT3: antithrombin III, APTT: activated partial thromboplastin time, PT-INR: prothrombin timeinternational normal ratio