Case Report: Perioperative Use of Protein C Concentrate for Protein C Deficiency in THA

Abstract

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.

Successful perioperative management using prothrombin complex concentrates in patients with severe congenital protein C deficiency

“…Good management of three patients with treatment using dried concentrated activated protein C and two patients using ZPC treatment was previously reported. 5,6,[9][10][11] In particular, Ceprotin and Protexel have been studied and are available in Europe and the United States. ZPC administration is not approved in Japan; further, dried concentrated activated protein C has not been used for perioperative management and such an agent is difficult to monitor.…”

“…4 However, methods and reports for the perioperative management of patients with congenital protein C deficiency are limited. 5,6 Therefore, this study aimed to intermittently administer PCC and examine its outcome as a perioperative management approach for severe congenital protein C deficiency.…”

Faktor Perilaku Pencegahan Penularan TB dengan Pendekatan Health Promotion Model

“…Hasil penelitian ini tidak sejalan dengan beberapa penelitian sebelumnya, dimana penelitian sebelumnya menjelaskan bahwa kurangnya pasokan alat untuk pengendalian infeksi dan kurangnya sarana mengakibatkan ketidakpatuhan pada perilaku pencegahan penularan Tb paru (Khaund, Sudhakar and Vaz, 2018), dengan perilaku pencegahan penularan Tb paru, adanya hubungan yang signifikan antara self efficacy dengan perilaku pencegahan Tb paru (Nurhayati, Kurniawan and Mardiah, 2015), adanya hubungan antara sikap yang berhubungan dengan aktivitas dengan tindakan pencegahan TBC pada remaja di Notoprajan Kecamatan Ngampilan kota Yogyakarta (Rahmawati, 2017), adanya hubungan antara lingkungan dengan perilaku pencegahan dimana tempat yang kekurangan sirkulasi udara akan sangat beresiko terhadap penularan Tb paru (Hella et al, 2017).…”

Hypercoagulable Disorders in Orthopaedics: Etiology, Considerations, and Management

“…While there is a considerable amount of guidance on the management of HCDs in other medical specialties, there are limited established guidelines for management in the orthopaedic patient. Although various studies exist examining the effect of certain HCDs on orthopaedic outcomes, there are no large studies examining the prevalence of HCDs in the orthopaedic patient population, nor are there any studies that have sought to determine the likelihood of a VTE in patients with an HCD undergoing orthopaedic procedures [7][8][9][10][11][12][13][14][15] .…”