A Case of Treatment With Dabigatran for Cerebral Venous Thrombosis Caused by Hereditary Protein C Deficiency

Fukushima, Taiki; Shimomura, Yoshimitsu; Nagaya, Satomi; Morishita, Eriko; Kawakami, Osamu

doi:10.7759/cureus.15473

Cited by 3 publications

(4 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10 At 8 months, imaging studies were consistent with complete resolution of the thrombotic event and sphenoidal rhinosinusitis. The continuation of anticoagulation with a direct oral anticoagulant (Dabigatran) after hospitalization showed no recurrence of thrombotic events, similar to what was reported by Fukushima et al 9 The limitation of this case is the uncertainty about its infectious etiology. Cultures resulted negative and a nasopharyngeal swab for was not performed.…”

Section: Discussionsupporting

confidence: 87%

“…This is unlike a case described by Fukushima et al where normal plasmatic Protein C levels increased the suspicion of type 2 PCD and their patient presented with and paralysis. 9 The diagnosis of our patient was established by referring to the Protein C activity assay using the immunofluorescence method. However, genetic analysis was preferred in Fukushima´s et al report.…”

Section: Discussionmentioning

confidence: 99%

“…However, genetic analysis was preferred in Fukushima´s et al report. 9 The risk of venous thromboembolism in patients with PCD is around 3-8%. 1 Cavernous thrombosis as a complication of an infectious process is more common in patients that have prothrombotic risk factors, such as deficiency of coagulation factors, trauma, smoking, oral contraceptive pills use, or previous surgery (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Hypercoagulability and Cavernous Sinus Thrombosis due to Protein C Deficiency. A Case Report

2023

View full text Add to dashboard Cite

Background: Thrombophilia due to Protein C deficiency is a rare condition, present in 0.2% of general population. Cerebral venous thrombosis has an incidence of 3-4 cases per million in adults. A combination of both is very uncommon. Patients with these conditions are prone to life-threatening superinfections. Case: A 51-year-old woman presented with pressing frontal headache accompanied with left periorbital edema, fever, diplopia, and disorientation. Laboratory findings showed low protein C levels. Computed tomography demonstrated sphenoidal rhinosinusitis. Magnetic resonance venography revealed cavernous sinus thrombosis. The patient was started on empiric antibiotic treatment (vancomycin, ceftriaxone, and metronidazole) and anticoagulants. Conclusion: This case report emphasizes the importance of early diagnosis and appropriate management of patients with protein C deficiency complicated by septic cavernous sinus thrombosis. Background: Thrombophilia due to Protein C deficiency is a rare condition, present in 0.2% of general population. Cerebral venous thrombosis has an incidence of 3-4 cases per million in adults. A combination of both is very uncommon. Patients with these conditions are prone to life-threatening superinfections. Case: A 51-year-old woman presented with pressing frontal headache accompanied with left periorbital edema, fever, diplopia, and disorientation. Laboratory findings showed low protein C levels. Computed tomography demonstrated sphenoidal rhinosinusitis. Magnetic resonance venography revealed cavernous sinus thrombosis. The patient was started on empiric antibiotic treatment (vancomycin, ceftriaxone, and metronidazole) and anticoagulants. Conclusion: This case report emphasizes the importance of early diagnosis and appropriate management of patients with protein C deficiency complicated by septic cavernous sinus thrombosis.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hypercoagulability and Cavernous Sinus Thrombosis due to Protein C Deficiency. A Case Report

2023

View full text Add to dashboard Cite

show abstract

“…5,6 Dabigatran etexilate, a direct inhibitor of the coagulation pathway's IIa factor, is one of the most promising NOACs for CVT therapy. [7][8][9] RE-SPECT CVT trial is pivotal in investigating this topic and the only RCT conducted with dabigatran specifically in adult patients diagnosed with CVT. 10,11 Further validation of dabigatran's efficacy in the Chinese population is warranted.…”

Section: Introductionmentioning

confidence: 99%

Dabigatran etexilate versus warfarin in cerebral venous thrombosis in Chinese patients (CHOICE-CVT): An open-label, randomized controlled trial

Ma,

Gu,

Bian

et al. 2024

International Journal of Stroke

View full text Add to dashboard Cite

Background: The efficacy and safety of dabigatran etexilate for Chinese patients with cerebral venous thrombosis (CVT) has not been well established. Methods: CHOICE-CVT was an exploratory, single-center, randomized, open-label study in the National Center for Neurological Disorders involving Chinese patients with CVT aged 18 to 80 years who were randomly assigned (1:1) to either dabigatran etexilate or warfarin. Oral anticoagulants were initiated after 10-15 days of LMWH. The primary efficacy and safety endpoints included the number of patients with recurrent CVT and/or deep venous thrombosis (DVT) and major clinical bleeding within 180 days. Secondary efficacy endpoints included venous recanalization and change in papilledema at day 180. Secondary safety outcomes comprised death, clinical non-major bleeding, and any bleeding. The study was registered with ClinicalTrials.gov under NCT03930940. Results: Between October 2017 and February 2023, a total of 89 patients were enrolled and randomly assigned to receive either dabigatran etexilate (n=44) or warfarin (n=45). At day 180, the dabigatran etexilate group showed a statistically non-significant but likely clinically significant number of patients with recurrent CVT and/or DVT (8 [18.2%; 95%CI, 6.3-30.0] vs 3 [6.7%; 95%CI, 0.0-14.2], P=0.099, with a power [1-β] of 38.401%) compared to the warfarin group. The dabigatran etexilate group showed a comparable number of patients with clinical major bleeding (0 [0] vs 0 [0], P=1.000), and clinical non-major bleeding (1 [2.3%; 95%CI, 0.0-6.9] vs 1 [2.2%; 95%CI, 0.0-6.7]) but demonstrated a lower risk of any bleeding (1 [2.3%; 95%CI, 0.0-6.9] vs 9 [20.0%; 95%CI, 7.8-32.2]) compared to the warfarin group. Most patients in both groups achieved venous recanalization according to the Modified Qureshi scale (27 [75%; 95%CI, 60.1-89.9] in the dabigatran etexilate group versus 34 [82.9%; 95%CI, 70.9-95.0] in the warfarin group) and exhibited improvement in papilledema as per the Frisén classification (35 [97.2%; 95%CI, 91.6-100.0] in dabigatran etexilate group vs. 37 [88.1%, 95%CI, 77.9-98.3] in warfarin group). Conclusions: These findings regarding efficacy and safety support the consideration of dabigatran etexilate therapy as a viable treatment option for Chinese patients with CVT.

show abstract

Analysis of PROC mutations and clinical features in 22 unrelated families with inherited protein C deficiency

Xu,

Zhang,

et al. 2023

Ann Hematol

View full text Add to dashboard Cite

A Case of Treatment With Dabigatran for Cerebral Venous Thrombosis Caused by Hereditary Protein C Deficiency

Cited by 3 publications

References 15 publications

Hypercoagulability and Cavernous Sinus Thrombosis due to Protein C Deficiency. A Case Report

Hypercoagulability and Cavernous Sinus Thrombosis due to Protein C Deficiency. A Case Report

Dabigatran etexilate versus warfarin in cerebral venous thrombosis in Chinese patients (CHOICE-CVT): An open-label, randomized controlled trial

Analysis of PROC mutations and clinical features in 22 unrelated families with inherited protein C deficiency

Contact Info

Product

Resources

About