title: Combined protein C deficiency and protein C activated resistance as a cause of caval, peripheral, and cerebral venous thrombosis--a case report.
abstract: A 26-year-old woman suffered concomitant inferior vena cava, iliac, and femoral vein thrombosis and cerebral venous thrombosis. Ten days before symptom onset she had started using an oral contraceptive that contained low-dose ethynilestradiol and gestodene. Both protein C deficiency and protein C activated resistance were detected. To our knowledge, the association of cerebral, caval, and ilio-femoral-popliteal venous thrombosis has not been described previously. The severity of the clinical features could be a consequence of the two combined thrombophilic mechanisms and of the continuation of the oral contraceptive. A thrombophilic disorder should be considered in young patients with thromboembolic disease. Because of the high prevalence of the genetic deficiency causing protein C activated resistance, it is probably worthwhile to perform general screening before prescription of oral contraceptives.
authors.affiliation: 2nd Division of Internal Medicine, University of Bari, Azienda Ospedaliera Policlinico, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Pugliese
authors.forename: G
authors.initials: G
authors.lastname: Nicoletti
authors.forename: C
authors.initials: C
authors.lastname: Andreula
authors.forename: M
authors.initials: M
authors.lastname: Ciccone
authors.forename: G
authors.initials: G
authors.lastname: Triggiani
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000209:etiology; D002550:Cerebral Veins; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D003280:Contraceptives, Oral, Synthetic / Q000627:therapeutic use; D004351:Drug Resistance / Q000235:genetics; D045166:Estradiol Congeners / Q000627:therapeutic use; D004997:Ethinyl Estradiol / Q000627:therapeutic use; D005260:Female; D005268:Femoral Vein; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein; D002542:Intracranial Embolism and Thrombosis / Q000188:drug therapy / Q000209:etiology*; D009652:Norpregnenes / Q000627:therapeutic use; D011152:Popliteal Vein; D015995:Prevalence; D045167:Progesterone Congeners / Q000627:therapeutic use; D011486:Protein C / Q000235:genetics; D020151:Protein C Deficiency; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology*; D014682:Vena Cava, Inferior; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D003278:Contraceptives, Oral, Hormonal; D003280:Contraceptives, Oral, Synthetic; D045166:Estradiol Congeners; D009652:Norpregnenes; D045167:Progesterone Congeners; D011486:Protein C; C033273:Gestodene; D004997:Ethinyl Estradiol; D014859:Warfarin