Protein C Deficiency Follow-up
- Author: Adam Cuker, MD, MS; Chief Editor: Perumal Thiagarajan, MD more...
Venous thromboembolism prevention
Thromboprophylaxis should be considered for surgery, pregnancy and the puerperium, trauma, and prolonged air travel in individuals with heterozygous protein C deficiency, particularly if there is a strong family history of thrombosis. Similarly, estrogen-containing hormonal therapy should only be used in such patients after careful consideration of the thrombotic risk.
Warfarin-induced skin necrosis prevention
For patients with heterozygous protein C deficiency, the following is recommended in order to avoid the development of WISN:
- Large loading doses of warfarin (>5 mg/d) should be avoided.
- When warfarin is initiated, it should be overlapped with a parenteral anticoagulant such as unfractionated or low molecular weight heparin.
- The parenteral anticoagulant should be continued for at least 5 days and until the international normalized ratio (INR) measurement has been 2.0 or greater for at least 2 days.
See the list below:
- Patients with protein C deficiency should be advised of the presenting signs and symptoms of VTE.
- Patients who are not maintained on anticoagulation should speak with their physician about thromboprophylaxis during events associated with an elevated risk of thrombosis such as surgery, trauma, immobilization, pregnancy, and the postpartum period.
- Patients on warfarin should be advised of the importance of maintaining a regular diet and notifying their physician when changes to their medications have been made.
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