Protein-C deficiency presenting as pulmonary embolism and myocardial infarction in the same patient

Maqbool, Syed; Rastogi, Vishal; Seth, Ashok; Singh, Satbir; Kumar, Vijay; Mustaqueem, Arif

doi:10.1186/1477-9560-11-19

Cited by 14 publications

(16 citation statements)

References 18 publications

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“…Protein C and antithrombin are natural plasma proteins that play an important role in the process of anticoagulation. Their deficiency leads to the development of procoagulant conditions, and one of the complications can be artery thrombosis [9][10][11][12][13] . The asso-ciation of stress caused by ischemia, quantified by dobutamine stress echocardiography (DSE), and changes in platelet function and other parameters of hemostasis in patients after the PCI, have not been tested so far.…”

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confidence: 99%

Platelet aggregability and anticoagulant proteins activity during dobutamine stress echocardiography in asymptomatic patients four months after percutaneous coronary intervention

et al. 2019

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Background/Aim. Platelets aggregability (PA) and the activation of hemostasis during myocardial ischemia within physical or mental stress, can be one of many factors that influence the process of stent thrombosis after the percutaneous coronary intervention (PCI). The aim of the study is to investigate the relationship between the PA and activity of anticoagulant proteins with myocardial ischemia during the dobutamine stress echocardiography (DSE) in the asymptomatic patients 4 months after the PCI. Methods. The study population included 74 asymptomatic patients who had a successful PCI 4 months before a high-dose DSE. PA on epinephrine (EPI) and adenosine diphosphate (ADP) were determined by the Light Transmission Aggregometry (LTA), together with plasma activity of protein C and antithrombin before the DSE and at the peak stage of the stress test. The patients were divided into several groups on the basis of whether they have baseline or induced disturbance of segmental myocardial kinetics or not. All patients were on the clopidogrel and aspirin therapy at the time of DSE. Results. There were no statistically significant difference in the PA ADP (47.50% vs 50.20%; p = 0.970) as well as on EPI (59.30% vs 60.30%, p = 0.600) before and at the peak of DSE. A statistically significant difference was found in the anticoagulant activity of the antithrombin (84.85% vs 74.75%, p = 0.001) and protein C (77.75% vs 67.60%, p < 0.001). A significance of differences in antithrombin and the protein C, refered to the result before and at the peak levels of the test. There was no significant difference in the PA and plasma activity of anticoagulant proteins in the patients with or without induced myocardial ischemia at the peak of DSE. The patients who had an increased wall motion score index at the peak of DSE, had a higher EPI induced PA than the patients with normal myocardial contractility (68.60% vs 54.70%, respectively; p = 0.017). Conclusion. There are no changes in the PA before and after DSE, however, plasma activity of anticoagulant proteins decreased at the peak level of the test. The PA on EPI significantly increases at the peak of DSE in the patients with segmental myocardial hypocontractility.

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Section: Introductionmentioning

confidence: 99%

Platelet aggregability and anticoagulant proteins activity during dobutamine stress echocardiography in asymptomatic patients four months after percutaneous coronary intervention

et al. 2019

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“…1,3 Protein C deficiency typically causes venous thromboembolism. However few case reports of arterial thrombosis due to congenital protein C deficiency involving cardiac and cerebral vessels in young adults have been reported, [4][5][6][7][8][9][10][11][12] though larger studies give conflicting data regarding existence of association between protein C deficiency and arterial thrombosis. [13][14][15][16][17] We report a case of congenital protein C deficiency with acute myocardial infarction in a young adult without major underlying coronary risk factors.…”

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confidence: 99%

“…1 However, many affected individuals remain asymptomatic throughout life. 12 There are several case reports of arterial thrombosis including stroke, myocardial infarction and peripheral arterial thrombosis. However, the results of larger studies have reported against protein c deficiency causing arterial thrombosis.…”

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confidence: 99%

“…Rest of the patients were thrombolysed but coronaries remained totally occluded in 3 and partially in one. 6,12 For asymptomatic patients without any risk factors or strong family history, no treatment is necessary. For asymptomatic patients but with one or more risk factors should be considered for oral vitamin K antagonist such as warfarin or oral Xa inhibitor such as rivaroxaban may be given.…”

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Unusual Presentation of Congenital Protein C Deficiency as Arterial Thrombosis along with Venous Thromboembolism

Khan¹,

Ahmed

Abdullah

et al. 2017

Univ. Heart J.

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“…[6] In most patients thrombosis is rare until their early 20s, with increasing numbers experiencing thrombotic events as they reach the age of 50 years. Cases of cerebral [7,8], myocardial [7,9], and mesenteric [10] infarction caused by protein C deficiency have been reported.…”

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confidence: 99%

Unexpected Multiple Organ Infarctions in a Poisoned Patient

Park¹,

Han²,

Yeom³

et al. 2015

Korean J Crit Care Med

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Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.

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Protein-C deficiency presenting as pulmonary embolism and myocardial infarction in the same patient

Cited by 14 publications

References 18 publications

Platelet aggregability and anticoagulant proteins activity during dobutamine stress echocardiography in asymptomatic patients four months after percutaneous coronary intervention

Platelet aggregability and anticoagulant proteins activity during dobutamine stress echocardiography in asymptomatic patients four months after percutaneous coronary intervention

Unusual Presentation of Congenital Protein C Deficiency as Arterial Thrombosis along with Venous Thromboembolism

Unexpected Multiple Organ Infarctions in a Poisoned Patient

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