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A Cause of Unusual or Unexplained Thrombosis

David F. J. Tollefson, MD; Kenneth D. Friedman, MD; Richard A. Marlar, PhD; Dennis F. Bandyk, MD; Jonathan B. Towne, MD

Arch Surg. 1988;123(7):881-884.

Abstract
• Familial hypercoagulable states are a collection of syndromes characterized by an inherited deficiency of various proteins involved in the control of coagulation and include antithrombin III, plasminogen, protein C, and protein S. Affected patients usually develop venous thrombosis as adults. During a 15-month interval, we identified five patients with venous thrombosis accompanied by protein C deficiency. Four patients presented with deep venous thrombosis, which was recurrent in two, and one patient developed mesenteric venous thrombosis. The kindred of this last patient suggested an autosomal dominant genetic transmission of protein C deficiency. Patients' ages at the time of diagnosis of disease ranged from 28 to 41 years. All patients had low levels of protein C (range, 34 to 67 U/dL; normal, 70 to 130 U/dL). All patients were treated with heparin sodium immediately and then given long-term oral anticoagulation therapy with warfarin sodium. Protein C deficiency is a predisposing factor to the development of venous thrombosis that has only recently been recognized. Treatment of symptomatic protein C deficiency requires short-term heparin therapy followed by long-term oral anticoagulation therapy with warfarin. Oral anticoagulation treatment must be initiated slowly with no loading dose to avoid warfarin-associated skin necrosis. Patients with unexplained or unusual thrombosis, especially if it occurs at an early age, and patients with recurrent episodes of lower limb venous thrombosis should have their protein C levels measured. If a deficiency is documented, long-term warfarin anticoagulation therapy is recommended.

(Arch Surg 1988;123:881-884)

Author Affiliations
From the Department of Surgery, Medical College of Wisconsin (Drs Tollefson, Bandyk, and Towne), and The Blood Center of Southeastern Wisconsin (Drs Friedman and Marlar), Milwaukee.

Footnotes
Accepted for publication Jan 5, 1988.

Read before the 95th Annual Meeting of the Western Surgical Association, Dallas, Nov 17, 1987.

Reprint requests to Department of Surgery, MCMC, 8700 W Wisconsin Ave, Milwaukee, WI 53226 (Dr Towne).

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