The role of antithrombin III in clinical management of pulmonary embolization

Review of hypercoagulability syndromes: what the interventionalist needs to know

Although none of these syndromes are very common, they are nevertheless of sufficient prevalence to be identified on occasion in the practice of the busy interventionalist or surgeon. Furthermore, it is anticipated that many more specific hypercoagulability disorders will be identified in the future. Therefore, it is necessary for the nonhematologist practitioner to be aware of their existence and to know when to seek hematology consultation to appropriately evaluate suspected individuals. Several clinical indicators should raise one's index of suspicion. One should be concerned about the patient with a strong family history of recurrent arterial and/or venous thrombosis or a history of previous arterial and/or venous thromboemboli without predisposing factors. Laboratory screening should be initiated for the patient who has had thrombotic events occurring at unusual sites, such as the upper extremity or mesenteric venous circulations, or in young patients presenting with thrombotic events. Patients with chronic arteriosclerotic disease at a young age, with evidence of rapidly progressive atherosclerotic lesions, and especially those who experience early occlusion after uncomplicated surgical or endovascular procedures warrant evaluation. Furthermore, patients manifesting a resistance to therapeutic anticoagulation with conventional agents may also be affected by one of these disorders. Identification of an underlying hypercoagulability disorder will not only influence the decision to proceed with a therapeutic intervention for noncritical arterial insufficiency but will also dictate appropriate pharmacologic management of the hypercoagulable patient to reduce potential thrombotic complications when vascular interventions are performed.

Perturbation of fibrinolysis inhibitors in progressive systemic sclerosis

Significance of fibrinolysis in pathophysiology of progressive systemic sclerosis (PSS) has been the subject of much speculation. Renal disease in PSS was associated with significant depression of an inhibitor of fibrinolysis, antithrombin III (ATIII), independent of general disease activity. Association of ATIII depression with plasminogen consumption supports an active role for plasmin or another ATIII-inhibitable enzyme in the pathophysiology of renal disease in PSS, and may explain the thrombotic tendency and propensity for fibrin deposition.