Anaesthetic Management of the Parturient with Protein S Deficiency and Lumboperitoneal Shunt

Gupta, Babita; Prakash, Smita; Gujral, K

doi:10.1177/0310057x0303100513

Cited by 5 publications

(12 citation statements)

References 25 publications

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“…Elevated plasma levels of d ‐dimer are associated with increased risk of future incident VTE 34 and plasma kallikrein has been associated with an increased risk for both arterial and venous thrombosis 35 . Of the anticoagulant proteins reported here, mild protein S deficiency has been associated with recurrent episodes of VTEs, 36,37 whilst inherited deficiencies of HCII have been reported that, in some cases, may be associated with an increased risk of VTE, though this is not always the case 38 …”

Section: Discussionmentioning

confidence: 83%

Coagulation factor dysregulation in polycystic ovary syndrome is an epiphenomenon of obesity

Moin

Sathyapalan

Butler

et al. 2023

Clinical Endocrinology

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Objective Obese women with polycystic ovary syndrome (PCOS) exhibit a hypercoagulable state, with the suggestion that this may be obesity‐driven rather than an intrinsic facet of PCOS; however, this has not yet been definitively determined since body mass index (BMI) is so highly correlated with PCOS. Therefore, only a study design where obesity, insulin resistance and inflammation are matched can answer this question. Design This was a cohort study. Patients Weight and aged‐matched nonobese women with PCOS (n = 29) and control women (n = 29) were included. Measurements Plasma coagulation pathway protein levels were measured. Circulating levels of a panel of nine clotting proteins known to differ in obese women with PCOS were determined by Slow Off‐rate Modified Aptamer (SOMA)‐scan plasma protein measurement. Results Women with PCOS showed a higher free androgen index (FAI) and anti‐Müllerian hormone, but measures of insulin resistance, and C reactive protein (as a marker of inflammation), did not differ between the nonobese women with PCOS and the control women. Seven pro‐coagulation proteins (plasminogen activator inhibitor‐1, fibrinogen, fibrinogen gamma chain, fibronectin, d‐dimer, P‐selectin and plasma kallikrein) and two anticoagulant proteins (vitamin K‐dependent protein‐S and heparin cofactor‐II) known to be elevated in obese women with PCOS did not differ from controls in this cohort. Conclusions This novel data show that clotting system abnormalities do not contribute to the intrinsic mechanisms underlying PCOS in this nonobese noninsulin resistant population of women with PCOS matched for age and BMI, and without evidence of underlying inflammation, but rather the clotting factor changes are an epiphenomenon coincident with obesity; therefore, increased coagulability is unlikely in these nonobese PCOS women.

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Section: Discussionmentioning

confidence: 83%

Coagulation factor dysregulation in polycystic ovary syndrome is an epiphenomenon of obesity

Moin

Sathyapalan

Butler

et al. 2023

Clinical Endocrinology

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“…PS deficiency is an uncommon condition characterized by reduced PS activity, a serine protease present in blood plasma that holds intricate roles in coagulation, inflammation, and apoptosis (VTE) [1]. There are three distinct forms of PS deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…PS deficiency commonly manifests as VTE and recurrent pregnancy loss, with arterial thrombosis being a rare occurrence [1]. Here, we present a case involving inherited PS deficiency resulting in extensive arterial thrombosis of the bilateral lower limb.…”

Section: Introductionmentioning

confidence: 95%

“…One of its primary roles involves assisting activated protein C (APC) in the regulation of activated factor V (FVa) and activated factor VII (FVIIa). When there is a deficiency in PS, it leads to an inability to effectively manage coagulation, resulting in excessive blood clot formation (thrombophilia) and the occurrence of venous thromboembolism (VTE) [1].…”

Section: Introductionmentioning

confidence: 99%

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Hereditary Protein S Deficiency With an Extensive Femoral Artery Thrombosis

Mohd Noor,

Che Anuar,

Saidin

et al. 2023

Cureus

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Protein S (PS) deficiency is widely recognized for its connection to venous thromboembolism risk. However, the relation between PS deficiency and arterial thrombotic events (ATEs) remains uncertain. Here, we report a patient who experienced an ATE with a family history of PS deficiency. We highlight an attention to the issues related to the management of arterial thrombotic events and discuss the potential use of antiplatelet therapy as a treatment option for a specific group of patients diagnosed with PS deficiency.

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“…Al margen de la técnica anestésica que se elija, se debe dar prioridad a la monitorización y evitar la disminución del gasto cardiaco, hipotermia, hipovolemia intraoperatoria y hemorragias, ya que esto se asocia a mayor riesgo de trombosis en pacientes con déficit de proteína S. La profilaxis posparto debe mantenerse por lo menos durante seis semanas con HBPM. [5][6][7] Se decidió realizar la técnica espinal en esta paciente debido a su sencillez, a la calidad anestésica y al pequeño calibre de la aguja utilizada. Sin embargo, al alta se debió considerar continuar con tromboprofilaxis, dado el riesgo de desarrollar alg un evento tromboembólico durante el estado puerperal.…”

Section: Discussionunclassified

Spinal anesthesia for c-section in patients with protein S deficiency

Carrillo-Aybar¹,

Moreno-Gonzales²,

Quispe-Gómez³

2020

Colombian Journal of Anesthesiology

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Introducción: La deficiencia congénita de proteína S es una enfermedad muy rara en la población. En gestantes está asociada a aborto espontáneo y muerte fetal, entre otras complicaciones. Presentación del caso: Presentamos el caso de una multigesta de 32 años con embarazo de 36 semanas, con tromboprofilaxis con enoxaparina desde la semana cuarta de gestación y con diagnóstico de trombofilia-por deficiencia de proteína S funcional-, la cual fue intervenida con cesárea electiva bajo anestesia espinal. Además, se realizó revisión de la literatura al respecto. Discusión: El riesgo de tromboembolismo venoso es aproximadamente 4 a 5 veces mayor durante la gestación, y la recomendación de tromboprofilaxis en trombofilias de bajo riesgo se basa en la presencia de factores de riesgo asociados. En pacientes que reciben Heparinas de Bajo Peso Molecular (HBPM) como tromboprofilaxis, se recomienda un intervalo de al menos 12 horas después de la ultima dosis de HBPM antes de la punción del neuroeje, y reiniciar la siguiente dosis después de al menos 4 horas de uso de la técnica espinal. Conclusión: Las técnicas neuroaxiales deben ser individualizadas y recibir tromboprofilaxis pre y posparto. Además, se deben tener en cuenta las medidas de tromboprofilaxis no farmacológicas en el periodo perioperatorio. La anestesia espinal fue efectiva y segura en esta paciente.

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Anaesthetic Management of the Parturient with Protein S Deficiency and Lumboperitoneal Shunt

Cited by 5 publications

References 25 publications

Coagulation factor dysregulation in polycystic ovary syndrome is an epiphenomenon of obesity

Coagulation factor dysregulation in polycystic ovary syndrome is an epiphenomenon of obesity

Hereditary Protein S Deficiency With an Extensive Femoral Artery Thrombosis

Spinal anesthesia for c-section in patients with protein S deficiency

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