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.
N1 - Funding Information:
One of the authors (SCT) has received funding from the Doris Duke Charitable Foundation to The Johns Hopkins University School of Medicine. Each author certifies that his or her institution approved or waived approval for the reporting of this case, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at The Johns Hopkins Medical Institutions.
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.
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U2 - 10.1007/s11999-009-1189-8
DO - 10.1007/s11999-009-1189-8
M3 - Article
C2 - 20012238
AN - SCOPUS:77954004795
SN - 0009-921X
VL - 468
SP - 1986
EP - 1990
JO - Clinical orthopaedics and related research
JF - Clinical orthopaedics and related research
IS - 7
ER -