Management of severe congenital protein C deficiency with a direct oral anticoagulant, edoxaban: A case report

2019 ◽  
Vol 66 (6) ◽  
pp. e27686 ◽  
Author(s):  
Kentaro Watanabe ◽  
Yuki Arakawa ◽  
Masato Yanagi ◽  
Kiyotaka Isobe ◽  
Makiko Mori ◽  
...  
Keyword(s):  
Case Report ◽  
Oral Anticoagulant ◽  
Protein C ◽  
Direct Oral Anticoagulant ◽  
Protein C Deficiency ◽  
Congenital Protein C Deficiency

Rivaroxaban Prophylaxis in Severe Congenital Protein C Deficiency

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4945-4945 ◽  
Author(s):  
Gabriel Salinas Cisneros ◽  
Ziad Khatib
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Skin Necrosis ◽  
Protein C ◽  
Autosomal Recessive ◽  
Protein S ◽  
Thrombin Inhibitor ◽  
Protein C Deficiency ◽  
Congenital Protein C Deficiency

Abstract INTRODUCTION Protein C is a vitamin K-dependent coagulation inhibitor produced by the hepatocytes. It is activated by the Thrombin-Thrombomodulin Complex, and in association with its cofactor, Protein S, induces proteolysis and inactivates Factor Va and Factor VIIIa thus limiting thrombin production. Congenital protein C deficiency may be inherited as an autosomal dominant disorder. Asymptomatic Protein C deficiency has been reported to be prevalent in 1 in 200 to 500 of healthy individuals, whereas the incidence of symptomatic deficiency is 1 in 20000. Autosomal recessive inheritance has been estimated to be around 1 in 4 million. CASE REPORT We report a case of a 19 year old male, ex 33 week-premature first twin baby from Thailand, diagnosed with severe Protein C Deficiency after presenting to a local hospital with an acute manifestation of bilateral leg swelling and purpura fulminans when he was 2 years old. At that time, his Protein C activity was 2%. He was initially treated with quarantined FFP replacement 10-15ml/kg weekly and LMWH and later warfarin. MRI done at that time showed evidence of prior ischemic events. Upon arrival to the US at 16 years of age his treatment with warfarin was continued. During the following year, he presented several times with complications including deep venous thrombosis, warfarin skin necrosis, bleeding and transient neurological deficits. He was started on rivaroxaban - a direct thrombin inhibitor- 20mg orally daily at 17 years of age. For the following two years he did well and had no other acute thrombotic, bleeding events or medication side effects. Follow up brain MRI showed no new areas of infarct. DISCUSSION No well-defined general guidelines are available for the treatment of symptomatic patients with severe congenital protein C deficiency. Current treatment for this condition focuses on to Protein C replacement with Fresh Frozen Plasma or an infusion of a human plasma-derived, viral inactivated protein C concentrate - such as ceprotin. It has been shown that patients with severe congenital Protein C deficiency were more effectively treated with Protein C concentrates than those treated with FFP or conventional anticoagulants. Nevertheless, Protein C concentrates requires supervision of an experienced physician and long-term treatments require the need of a central venous access. Side effects include higher risk of infections due to frequent transfusions, fluid overload, allergic reactions, high sodium intake, heparin induced thrombocytopenia and high cost. New anticoagulation medications open a window of possibilities for management of this medical condition. There is no literature on the use of rivaroxaban in children. Few studies have been done and most of them are case reports. In 2013, Martinelli et al published a case report of a 6 year old girl with severe protein S deficiency. Initially started on warfarin but had recurrent episodes of warfarin-induced skin necrosis. Her hypercoagulable state was due to warfarin-induced reduction of protein C so the switch of anticoagulant therapy to rivaroxaban resulted in the disappearance of skin necrosis at 1 year of follow-up. Our case demonstrates an autosomal recessive Protein C deficiency successfully managed with the use of direct Xa inhibitor- rivaroxaban- given orally on a daily basis. This treatment approach appears to be safe and effective and could be studied in prospective large cohorts of patients with Protein C deficiency. Disclosures No relevant conflicts of interest to declare.

PLEDs in an infant with congenital protein C deficiency: A case report

2010 ◽  
Vol 121 (5) ◽  
pp. 800-801 ◽  
Author(s):  
Kazuhito Sekiguchi ◽  
Kensuke Akiyoshi ◽  
Naho Okazaki ◽  
Hiroshi Yamada ◽  
Masayoshi Suzuki ◽  
...  
Keyword(s):  
Case Report ◽  
Protein C ◽  
Protein C Deficiency ◽  
Congenital Protein C Deficiency

scholarly journals Neonatal purpura fulminans in newborn with severe congenital protein C deficiency: Case report

2017 ◽  
Vol 21 (2) ◽  
pp. 104-106
Author(s):  
Sultan A. Jafarri ◽  
Khalid M. AlAttas ◽  
Sultan M. Bajawi ◽  
Mohammad K. Ahsan ◽  
Ali M. Al-Sheikh ◽  
...  
Keyword(s):  
Case Report ◽  
Protein C ◽  
Purpura Fulminans ◽  
Protein C Deficiency ◽  
Congenital Protein C Deficiency

scholarly journals Homozygous Protein C Deficiency in a Premature Infant- A Case Report

2017 ◽  
Author(s):  
Ravi Teja Juloori ◽  
Febe Renjitha Suman ◽  
Rithika Rajendran ◽  
B Uma Maheswari
Keyword(s):  
Case Report ◽  
Premature Infant ◽  
Protein C ◽  
Protein C Deficiency

Transient ischemic attack in a patient with congenital protein-c deficiency during treatment with stanozolol

1988 ◽  
Vol 29 (2) ◽  
pp. 120-121 ◽  
Author(s):  
Valerio de Stefano ◽  
Giuseppe Leone ◽  
Luciana Teofili ◽  
Rita Ferrelli ◽  
Giuseppe Pollari ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Protein C ◽  
Protein C Deficiency ◽  
Ischemic Attack ◽  
Congenital Protein C Deficiency

Purpura Fulminans in a Chinese Boy With Congenital Protein C Deficiency

PEDIATRICS ◽  
1986 ◽  
Vol 77 (5) ◽  
pp. 670-676
Author(s):  
Patrick Yuen ◽  
Alfred Cheung ◽  
Hsiang Ju Lin ◽  
Faith Ho ◽  
Jun Mimuro ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Protein C ◽  
Purpura Fulminans ◽  
Fresh Frozen Plasma ◽  
Protein C Deficiency ◽  
Intravascular Coagulation ◽  
The Family ◽  
Fresh Frozen ◽  
Frozen Plasma ◽  
Congenital Protein C Deficiency

Severe and recurrent purpura fulminans developed in a Chinese boy at one day of age. Results of coagulation studies performed on the patient during attacks were compatible with the diagnosis of disseminated intravascular coagulation. Subsequent investigations have revealed that the patient is homozygous and that his parents are heterozygous for protein C deficiency. Cryoprecipitate and fresh frozen plasma induced a remission, and administration of warfarin has been successful in preventing recurrence of attacks for as long as 8 months without infusion of any plasma components. None of the family members who are heterozygous for protein C deficiency have had thrombotic episodes.

scholarly journals Aortic Mural Thrombus Associated with Congenital Protein C Deficiency in an Elderly Patient

2020 ◽  
Vol 27 (1) ◽  
pp. 100-103
Author(s):  
Kazuki Ueda ◽  
Eriko Morishita ◽  
Hironaga Shiraki ◽  
Shunzo Matsuoka ◽  
Shinsaku Imashuku
Keyword(s):  
Elderly Patient ◽  
Protein C ◽  
Mural Thrombus ◽  
Protein C Deficiency ◽  
Congenital Protein C Deficiency
Sign in / Sign up

Export Citation Format

Share Document