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Case report: perioperative use of protein c concentrate for protein C deficiency in THA
Savyasachi C Thakkar1, Michael B Streiff, Duane F Bruley
1Department of Orthopaedic Surgery, The Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD, 21224-2780, USA.
Insights
Perioperative management of protein C deficiency patients undergoing total hip arthroplasty (THA) is complex. Human zymogen protein C concentrate safely prevented thrombosis and bleeding in a heterozygous protein C deficient patient during THA.
Area of Science:
- Medical Case Study
- Thrombophilia Management
- Surgical Risk Mitigation
Background:
- Managing patients with heterozygous protein C deficiency presents challenges due to risks of bleeding and thrombosis.
- Total hip arthroplasty (THA) carries significant risks of deep vein thrombosis (DVT) and pulmonary embolism (PE), especially in patients with thrombophilic defects.
- Protein C deficiency increases the risk of thrombotic events, complicating perioperative care.
Purpose of the Study:
- To describe the successful perioperative management of a patient with heterozygous protein C deficiency undergoing THA.
- To evaluate the safety and efficacy of human zymogen protein C concentrate in preventing thrombotic and bleeding complications during THA in a protein C deficient patient.
Main Methods:
- A 74-year-old male with protein C deficiency and a prothrombin G20210A mutation underwent a left THA.
- Perioperative management included anticoagulation with enoxaparin and administration of human zymogen protein C concentrate.
- Literature review of protein C concentrate use in perioperative settings for protein C deficient patients.
Main Results:
- The patient experienced a successful left THA with no excessive bleeding or hematoma formation.
- No evidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) was observed postoperatively.
- The perioperative use of human zymogen protein C concentrate was associated with a favorable outcome.
Conclusions:
- Human zymogen protein C concentrate can be a safe and effective adjunct in the perioperative management of THA patients with heterozygous protein C deficiency.
- This approach mitigates the competing risks of bleeding and thrombosis in high-risk surgical patients.
- Further research may support the broader application of protein C concentrate in similar clinical scenarios.
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 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.
Literature Review:
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.
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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