title: Thrombophilia in cardiac surgery--patients with protein S deficiency.
abstract: BACKGROUND
  Thrombophilic diathesis may cause severe problems in cardiac surgical patients. Among these, protein S deficiency is a coagulation disorder associated with recurrent thromboembolic events. We analyzed our experience with 7 patients with protein S deficiency who underwent cardiac surgery.
  
  
  METHODS
  We retrospectively reviewed the clinical data, operative and postoperative courses, and the long-term results of 7 patients who were diagnosed to have protein S deficiency. Six of them were operated on using cardiopulmonary bypass, one was operated on with an off-pump procedure.
  
  
  RESULTS
  Procedures performed were emergent pulmonary embolectomy (patient 1), aortic valve replacement and coronary artery bypass grafting (CABG, patient 2), re-CABG (patients 3 and 7), and CABG (patients 4, 5, and 6). In patients 1, 2, 3, and 7, the diagnosis was made perioperatively. Patients 4, 5, and 6 were treated with a modified regimen of warfarin or protamine. All of the latter 3 patients had an uneventful perioperative course without thromboembolic complication. At follow-up, all but 1 of the 7 patients were on continuous warfarin, and were well and without any further thromboembolic events.
  
  
  CONCLUSIONS
  In patients with a past medical history of thromboembolic events or with a perioperative thromboembolic complication, elaborate laboratory investigation should lead to a definite diagnosis. For instance, patients with protein S deficiency undergoing cardiac surgery belong to a high-risk subgroup. Although rare, this and other coagulation disorders can be a critical issue in cardiac surgery. In such patients, we suggest perioperative warfarin therapy with a target international normalized ratio of 2.0 and incomplete protamine antagonism to minimize the risk of a perioperative thromboembolic event.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center, Essen, Germany. parwis.massoudy@uni-essen.de
authors.forename: Parwis
authors.initials: P
authors.lastname: Massoudy
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Hannes
authors.initials: H
authors.lastname: Müller-Beissenhirtz
authors.forename: Ivan
authors.initials: I
authors.lastname: Aleksic
authors.forename: Günter
authors.initials: G
authors.lastname: Marggraf
authors.forename: Wulf
authors.initials: W
authors.lastname: Dietrich
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D017128:Embolectomy; D006331:Heart Diseases / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D018455:Protein S Deficiency / Q000150:complications* / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D019851:Thrombophilia / Q000209:etiology*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin