Case report: Perioperative use of protein C concentrate for protein C deficiency in THA

Savyasachi C. Thakkar, Michael B Streiff, Duane F. Bruley, Simon C. Mears

Research output: Contribution to journalArticle

Abstract

Background Perioperative management of patients with heterozygous protein C deficiency is challenging because of the competing risks of bleeding and recurrent thrombosis. Case Description We report the case of a 74-year-old man with protein C deficiency and heterozygous pro- thrombin G20210A gene mutation who had a successful left THA with perioperative administration of human zymogen protein C concentrate in addition to anticoagulation with enoxaparin. Literature Review Several studies have reported the use of protein C concentrate in severe sepsis-associated pur- pura fulminans in patients with severe congenital protein C deficiency who have had thrombotic events. We reviewed studies and case reports pertinent to the treatment of patients with protein C deficiency, especially in the perioperative setting. We report the case of a patient undergoing THA in whom we used human zymogen protein C concentrate. Purposes and Clinical Relevance THA, a particularly high-risk procedure, is associated with a 40% to 70% incidence of venographic deep venous thrombosis and a 2% to 3% incidence of symptomatic deep venous thrombosis. These risks are greater in people with thrombophilic defects such as protein C deficiency. The use of human zymogen protein C in our patient with heterozygous protein C deficiency during the perioperative period of a THA was associated with no evidence of excessive bleeding, hematoma, deep venous thrombosis, or pulmonary embolism.

Original languageEnglish (US)
Pages (from-to)1986-1990
Number of pages5
JournalClinical Orthopaedics and Related Research
Volume468
Issue number7
DOIs
StatePublished - Jul 2010

Fingerprint

Protein C Deficiency
Tacrine
Protein C
Enzyme Precursors
Venous Thrombosis
Hemorrhage
Enoxaparin
Perioperative Period
Incidence
Pulmonary Embolism
Thrombin
Hematoma
Sepsis
Thrombosis
Mutation
Genes

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Case report : Perioperative use of protein C concentrate for protein C deficiency in THA. / Thakkar, Savyasachi C.; Streiff, Michael B; Bruley, Duane F.; Mears, Simon C.

In: Clinical Orthopaedics and Related Research, Vol. 468, No. 7, 07.2010, p. 1986-1990.

Research output: Contribution to journalArticle

Thakkar, Savyasachi C. ; Streiff, Michael B ; Bruley, Duane F. ; Mears, Simon C. / Case report : Perioperative use of protein C concentrate for protein C deficiency in THA. In: Clinical Orthopaedics and Related Research. 2010 ; Vol. 468, No. 7. pp. 1986-1990.
@article{cc7c38ea937142cfb9986cf75fa224d4,
title = "Case report: Perioperative use of protein C concentrate for protein C deficiency in THA",
abstract = "Background Perioperative management of patients with heterozygous protein C deficiency is challenging because of the competing risks of bleeding and recurrent thrombosis. Case Description We report the case of a 74-year-old man with protein C deficiency and heterozygous pro- thrombin G20210A gene mutation who had a successful left THA with perioperative administration of human zymogen protein C concentrate in addition to anticoagulation with enoxaparin. Literature Review Several studies have reported the use of protein C concentrate in severe sepsis-associated pur- pura fulminans in patients with severe congenital protein C deficiency who have had thrombotic events. We reviewed studies and case reports pertinent to the treatment of patients with protein C deficiency, especially in the perioperative setting. We report the case of a patient undergoing THA in whom we used human zymogen protein C concentrate. Purposes and Clinical Relevance THA, a particularly high-risk procedure, is associated with a 40{\%} to 70{\%} incidence of venographic deep venous thrombosis and a 2{\%} to 3{\%} incidence of symptomatic deep venous thrombosis. These risks are greater in people with thrombophilic defects such as protein C deficiency. The use of human zymogen protein C in our patient with heterozygous protein C deficiency during the perioperative period of a THA was associated with no evidence of excessive bleeding, hematoma, deep venous thrombosis, or pulmonary embolism.",
author = "Thakkar, {Savyasachi C.} and Streiff, {Michael B} and Bruley, {Duane F.} and Mears, {Simon C.}",
year = "2010",
month = "7",
doi = "10.1007/s11999-009-1189-8",
language = "English (US)",
volume = "468",
pages = "1986--1990",
journal = "Clinical Orthopaedics and Related Research",
issn = "0009-921X",
publisher = "Springer New York",
number = "7",

}

TY - JOUR

T1 - Case report

T2 - Perioperative use of protein C concentrate for protein C deficiency in THA

AU - Thakkar, Savyasachi C.

AU - Streiff, Michael B

AU - Bruley, Duane F.

AU - Mears, Simon C.

PY - 2010/7

Y1 - 2010/7

N2 - Background Perioperative management of patients with heterozygous protein C deficiency is challenging because of the competing risks of bleeding and recurrent thrombosis. Case Description We report the case of a 74-year-old man with protein C deficiency and heterozygous pro- thrombin G20210A gene mutation who had a successful left THA with perioperative administration of human zymogen protein C concentrate in addition to anticoagulation with enoxaparin. Literature Review Several studies have reported the use of protein C concentrate in severe sepsis-associated pur- pura fulminans in patients with severe congenital protein C deficiency who have had thrombotic events. We reviewed studies and case reports pertinent to the treatment of patients with protein C deficiency, especially in the perioperative setting. We report the case of a patient undergoing THA in whom we used human zymogen protein C concentrate. Purposes and Clinical Relevance THA, a particularly high-risk procedure, is associated with a 40% to 70% incidence of venographic deep venous thrombosis and a 2% to 3% incidence of symptomatic deep venous thrombosis. These risks are greater in people with thrombophilic defects such as protein C deficiency. The use of human zymogen protein C in our patient with heterozygous protein C deficiency during the perioperative period of a THA was associated with no evidence of excessive bleeding, hematoma, deep venous thrombosis, or pulmonary embolism.

AB - Background Perioperative management of patients with heterozygous protein C deficiency is challenging because of the competing risks of bleeding and recurrent thrombosis. Case Description We report the case of a 74-year-old man with protein C deficiency and heterozygous pro- thrombin G20210A gene mutation who had a successful left THA with perioperative administration of human zymogen protein C concentrate in addition to anticoagulation with enoxaparin. Literature Review Several studies have reported the use of protein C concentrate in severe sepsis-associated pur- pura fulminans in patients with severe congenital protein C deficiency who have had thrombotic events. We reviewed studies and case reports pertinent to the treatment of patients with protein C deficiency, especially in the perioperative setting. We report the case of a patient undergoing THA in whom we used human zymogen protein C concentrate. Purposes and Clinical Relevance THA, a particularly high-risk procedure, is associated with a 40% to 70% incidence of venographic deep venous thrombosis and a 2% to 3% incidence of symptomatic deep venous thrombosis. These risks are greater in people with thrombophilic defects such as protein C deficiency. The use of human zymogen protein C in our patient with heterozygous protein C deficiency during the perioperative period of a THA was associated with no evidence of excessive bleeding, hematoma, deep venous thrombosis, or pulmonary embolism.

UR - http://www.scopus.com/inward/record.url?scp=77954004795&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954004795&partnerID=8YFLogxK

U2 - 10.1007/s11999-009-1189-8

DO - 10.1007/s11999-009-1189-8

M3 - Article

C2 - 20012238

AN - SCOPUS:77954004795

VL - 468

SP - 1986

EP - 1990

JO - Clinical Orthopaedics and Related Research

JF - Clinical Orthopaedics and Related Research

SN - 0009-921X

IS - 7

ER -