Antithrombin (AT) deficiency is a severe coagulation disorder with a 5-to 16-fold increased risk of venous thromboembolism (VTE). 1,2 Yet, diagnosis of AT deficiency is rather crude with current first-line activity tests measuring overall activity, potentially generating diagnostic uncertainty. Clinicians may therefore question the clinical relevance of results around the clinical decision levels (Figure 1A), even more so as the diagnosis may have an impact on clinical decisions and management.In pregnant women, AT deficiency poses an additional risk for thrombosis as pregnancy by itself already increases the risk of VTE by 5-to 50-fold. 3 Furthermore, obstetric complications, such as recurrent pregnancy loss (RPL), are increased in women with AT deficiency. [4][5][6] Recommendations and guidelines for thrombophilia screening in pregnant women, similar to general AT deficiency guidelines, are often conflicting or report insufficient evidence. [7][8][9] These guidelines justify thrombophilia screening only in women presenting with RPL and a positive (family) history of VTE, thereby potentially missing AT deficiency

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