Clinical application of a functional assay for protein C

Protein C (PC) is a vitamin K-dependent protein which functions as a physiologic anticoagulant. In the presence of another vitamin K-dependent protein, protein S, the activated form of protein C (APC) will degrade the active cofactors Va and VIIIa. Both hereditary and acquired deficiencies of PC have been associated with a predisposition to thromboembolic events. We have evaluated a commercial assay system (Stac lot Protein C) which utilizes an extract of snake venom (Protac) that directly activates protein C in vitro. Utilizing this assay, normal individuals, patients with hereditary protein C deficiency, patients who were stably anticoagulated with oral anticoagulants, and patients with lupus anticoagulants were evaluated. Significant discrepancies were noted between protein C antigen and protein C functional activity in patients receiving oral anticoagulants. In addition, patients with lupus anticoagulants may have falsely elevated values for functional protein C activity.