eMedicine Specialties > Hematology > Coagulation, Hemostasis, and Disorders

Protein C Deficiency: Follow-up

Author: Adam Cuker, MD, Fellowship in Hematology/Oncology, Hospital of the University of Pennsylvania
Coauthor(s): Eleanor S Pollak, MD, Associate Director of Special Coagulation, Associate Professor, Department of Pathology and Laboratory Medicine, Section of Hematology and Coagulation, University of Pennsylvania
Contributor Information and Disclosures

Updated: Jun 11, 2009

Follow-up

Deterrence/Prevention

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:

  • 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. 

Patient Education

  • 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, the postpartum period, and estrogen-containing hormonal therapy.
  • 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.

Miscellaneous

Medicolegal Pitfalls

Anticoagulant therapy carries a risk of major hemorrhage. A number of factors influence this risk including age, concomitant use of antiplatelet agents, and certain comorbid conditions. Among patients who have experienced a previous VTE, this risk must be balanced against the risk of recurrent VTE in determining the optimal duration of anticoagulation therapy. Because the risks and benefits of anticoagulation for a given individual may change over time, they should be reassessed on a regular basis. 

 


More on Protein C Deficiency

Overview: Protein C Deficiency
Differential Diagnoses & Workup: Protein C Deficiency
Treatment & Medication: Protein C Deficiency
Follow-up: Protein C Deficiency
Multimedia: Protein C Deficiency
References
Further Reading
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Further Reading

Related eMedicine Topics

Clinical Trials
National Guideline Clearinghouse

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Keywords

protein C deficiency, thrombophilia, hypercoagulability, venous thromboembolism, VTE, acquired protein C deficiency, warfarin-induced skin necrosis, WISN, neonatal purpura fulminans, NPF, activated protein C resistance, aPC, inherited blood coagulation disorders, inherited blood protein disorders

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Contributor Information and Disclosures

Author

Adam Cuker, MD, Fellowship in Hematology/Oncology, Hospital of the University of Pennsylvania
Adam Cuker, MD is a member of the following medical societies: American Society of Hematology, Hemophilia and Thrombosis Research Society, International Society on Thrombosis and Haemostasis, and National Hemophilia Foundation
Disclosure: Nothing to disclose.

Coauthor(s)

Eleanor S Pollak, MD, Associate Director of Special Coagulation, Associate Professor, Department of Pathology and Laboratory Medicine, Section of Hematology and Coagulation, University of Pennsylvania
Eleanor S Pollak, MD is a member of the following medical societies: American Society of Hematology, College of American Pathologists, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

Medical Editor

David Aboulafia, MD, Medical Director, Bailey-Boushay House; Clinical Professor, Department of Medicine, Division of Hematology, University of Washington
David Aboulafia, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Medical Directors Association, American Society of Hematology, Infectious Diseases Society of America, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Troy H Guthrie, Jr, MD, Director of Cancer Institute, Baptist Medical Center
Troy H Guthrie, Jr, MD is a member of the following medical societies: American Federation for Medical Research, American Medical Association, American Society of Hematology, Florida Medical Association, Medical Association of Georgia, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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