Case report: perioperative use of protein c concentrate for protein C deficiency in THA.
BACKGROUND
Perioperative management of patients with heterozygous protein C deficiency is challenging because of the competing risks of bleeding and recurrent thrombosis.


METHODS
We report the case of a 74-year-old man with protein C deficiency and heterozygous prothrombin G20210A gene mutation who had a successful left THA with perioperative administration of human zymogen protein C concentrate in addition to anticoagulation with enoxaparin.


METHODS
Several studies have reported the use of protein C concentrate in severe sepsis-associated purpura 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.


CONCLUSIONS
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.
Thakkar
Savyasachi C
SC
Department of Orthopaedic Surgery, The Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD, 21224-2780, USA.
Streiff
Michael B
MB
Bruley
Duane F
DF
Mears
Simon C
SC
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005838:Genotype; D006579:Heterozygote; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D009154:Mutation; D015207:Osteoarthritis, Hip / Q000150:complications / Q000601:surgery*; D011486:Protein C / Q000627:therapeutic use*; D020151:Protein C Deficiency / Q000150:complications / Q000188:drug therapy*; D011516:Prothrombin / Q000235:genetics; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants; D011486:Protein C; D011516:Prothrombin