A Case of Treatment With Dabigatran for Cerebral Venous Thrombosis Caused by Hereditary Protein C Deficiency

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2021 Jul 15

PMID 34262811

Citations 2

Authors

Taiki Fukushima

Yoshimitsu Shimomura

Satomi Nagaya

Eriko Morishita

Osamu Kawakami

Affiliations

Soon will be listed here.

Abstract

A 37-year-old woman was admitted to our hospital with involuntary movements. She had no medical or family history of thromboembolism, nor was she on any medication. She showed no impaired consciousness, cranial nerve abnormalities, abnormal breathing, stiff neck or paralysis. Magnetic resonance venography exhibited poor visualization of intracranial vein. The protein C activity level reduced but the protein C antigen level was normal. Genetic analysis revealed a heterozygous mutation in exon 7 c.577-579delAAG, p.Lys193del on protein C gene. She was diagnosed with cerebral venous thrombosis and hereditary protein C deficiency type II. She received heparin in acute phase, and switched to dabigatran in chronic phase. Consequently, she had no recurrence of cerebral venous thrombosis and other complications. Dabigatran might be one of the alternative choices for patients with cerebral venous thrombosis and protein C deficiency.

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References

Faust S, Levin M, Harrison O, Goldin R, Lockhart M, Kondaveeti S . Dysfunction of endothelial protein C activation in severe meningococcal sepsis. N Engl J Med. 2001; 345(6):408-16. DOI: 10.1056/NEJM200108093450603. View

Saposnik G, Barinagarrementeria F, Brown Jr R, Bushnell C, Cucchiara B, Cushman M . Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42(4):1158-92. DOI: 10.1161/STR.0b013e31820a8364. View

Mekaj Y, Mekaj A, Duci S, Miftari E . New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events. Ther Clin Risk Manag. 2015; 11:967-77. PMC: 4485791. DOI: 10.2147/TCRM.S84210. View

Menon N, Sarode R, Zia A . Rivaroxaban dose adjustment using thrombin generation in severe congenital protein C deficiency and warfarin-induced skin necrosis. Blood Adv. 2018; 2(2):142-145. PMC: 5787863. DOI: 10.1182/bloodadvances.2017012047. View

Skelley J, White C, Thomason A . The use of direct oral anticoagulants in inherited thrombophilia. J Thromb Thrombolysis. 2016; 43(1):24-30. DOI: 10.1007/s11239-016-1428-2. View

Maki H, Nishiyama M, Shirakawa M . Simultaneous Left Ventricular and Deep Vein Thrombi Caused by Protein C Deficiency. Case Rep Med. 2017; 2017:4240959. PMC: 5282415. DOI: 10.1155/2017/4240959. View

Majid Z, Tahir F, Ahmed J, Arif T, Haq A . Protein C Deficiency as a Risk Factor for Stroke in Young Adults: A Review. Cureus. 2020; 12(3):e7472. PMC: 7188017. DOI: 10.7759/cureus.7472. View

Dinarvand P, Moser K . Protein C Deficiency. Arch Pathol Lab Med. 2019; 143(10):1281-1285. DOI: 10.5858/arpa.2017-0403-RS. View

Mateo J, Oliver A, Borrell M, Sala N, Fontcuberta J . Laboratory evaluation and clinical characteristics of 2,132 consecutive unselected patients with venous thromboembolism--results of the Spanish Multicentric Study on Thrombophilia (EMET-Study). Thromb Haemost. 1997; 77(3):444-51. View

10.

Ferro J, Coutinho J, Dentali F, Kobayashi A, Alasheev A, Canhao P . Safety and Efficacy of Dabigatran Etexilate vs Dose-Adjusted Warfarin in Patients With Cerebral Venous Thrombosis: A Randomized Clinical Trial. JAMA Neurol. 2019; 76(12):1457-1465. PMC: 6724157. DOI: 10.1001/jamaneurol.2019.2764. View

11.

Lai J, Ramai D, Alchi R, Bloomfield D . Anticoagulation therapy for thromboembolism prevention: a case of warfarin-induced skin necrosis in the setting of protein C deficiency. BMJ Case Rep. 2017; 2017. PMC: 5747636. DOI: 10.1136/bcr-2016-218015. View

12.

Tait R, Walker I, Reitsma P, Islam S, MCCALL F, Poort S . Prevalence of protein C deficiency in the healthy population. Thromb Haemost. 1995; 73(1):87-93. View

13.

Miyata T, Sakata T, Yasumuro Y, Okamura T, Katsumi A, Saito H . Genetic analysis of protein C deficiency in nineteen Japanese families: five recurrent defects can explain half of the deficiencies. Thromb Res. 1998; 92(4):181-7. DOI: 10.1016/s0049-3848(98)00131-5. View

14.

Saito K, Ishii K, Furuta K, Kobayashi M, Wada Y, Morishita E . Recurrent Cerebral Venous Thrombosis Treated with Direct Oral Anticoagulants in a Japanese Man with Hereditary Protein C Deficiency. J Stroke Cerebrovasc Dis. 2020; 30(1):105320. DOI: 10.1016/j.jstrokecerebrovasdis.2020.105320. View

15.

Goldenberg N, Manco-Johnson M . Protein C deficiency. Haemophilia. 2009; 14(6):1214-21. DOI: 10.1111/j.1365-2516.2008.01838.x. View