Perioperative Management of Hereditary Antithrombin Deficiency in a Patient Undergoing Minimally Invasive Thoracic Surgery: A Case Report.

INTRODUCTION: Hereditary antithrombin deficiency is a rare congenital disorder associated with an increased risk of venous thromboembolism, particularly during high-risk situations such as surgery. Effective perioperative anticoagulation management is critical to prevent thromboembolic complications in these patients. CASE PRESENTATION: A 55-year-old female with a history of deep vein thrombosis and hereditary antithrombin deficiency presented with an anterior mediastinal tumor. Imaging findings suggested a benign cystic lesion; however, malignancy could not be completely excluded. A perioperative management strategy involving recombinant human antithrombin and heparin therapy was employed to safely perform uniportal robotic-assisted thymic cyst resection via a 4-cm incision in the right 5th intercostal space. Postoperative assessment, including clinical monitoring and follow-up imaging, confirmed the absence of thromboembolic complications. Histopathological examination revealed a benign thymic cyst. CONCLUSIONS: This case highlights the importance of individualized perioperative anticoagulation management in patients with hereditary antithrombin deficiency undergoing thoracic surgery. The combination of recombinant human antithrombin and heparin therapy provided effective anticoagulation, allowing successful surgical intervention without thromboembolic events. Establishing standardized protocols for the management of such high-risk patients is essential for improving surgical safety and outcomes.