We thank the authors for their comments and agree that depressed AT III levels may be the result of thrombosis rather than the cause. We do not think that this was the case in the patients we presented. The first patient was at least three weeks away from any short-term process when his AT III level was noted to be depressed. The second patient was noted to have low AT III levels four months after her vascular occlusion and well before gangrenous changes appeared.Although Marciniak et al reported increases in AT III levels by functional assay after warfarin administration, they did not report immunoassay data. More recently, there have been reports1,2 of patients with well-documented familial AT III deficiency whose immunologically measured AT III levels increased to normal or near-normal levels after warfarin therapy. Other workers3 have reported increased functional but not immunologic levels of
Shapiro ME, Salzman EW. Aortic Thrombosis in Antithrombin III Deficiency-Reply. JAMA. 1982;247(8):1127–1128. doi:10.1001/jama.1982.03320330023017
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