Thrombophilic disorders that predispose patients to develop
blood clots can be life-threatening and result in a large economic burden on healthcare expenditures.
Venous Thromboembolism(VTE) (
deep vein thrombosis and
pulmonary embolism) are the third leading cause of death in the United States.
Protein C deficiency is a common thrombophilic condition that affects an estimated 1 in 400 Americans.
Zymogen Protein C (ZPC) is the precursor to Activated
Protein C (APC), a pivotal endogenous
anticoagulant in human blood. Patients with
protein C deficiency who have roughly half the normal level of
protein C are estimated to be at 10-fold increased risk of VTE. We describe the use of
protein C concentrate (Ceprotin®, Baxter, Deerfield, IL) in a patient with
protein C deficiency and with a previous
pulmonary embolism who developed a life-threatening gastrointestinal bleed after polypectomy. The patient is a 75-year-old male at very high risk for
deep vein thrombosis and possible lung emboli. He has heterozygous
Protein C deficiency (50%) and heterozygosity for the
prothrombin gene G20210A mutation. During a routine colonoscopy, a large 3 cm cecal
polyp was identified and resected. Eight days post-procedure while performing abdominal exercise he developed a life-threatening GI bleed originating from the polypectomy site as his
warfarin was becoming therapeutic on a
Low Molecular Weight Heparin (
LMWH) periprocedural bridge. The patient's
warfarin was reversed with
vitamin K, and
LMWH and
warfarin were discontinued. To prevent
thrombosis, he was started on ZPC until anticoagulation could be safely restarted. During endoscopy, the
bleeding site was treated with an injection of 1:10,000 dilution of
epinephrine, followed by
cauterization and placement of endoclips (4
metal staples). Three days after endoscopic repair
LMWH was restarted with
warfarin. Sixteen months post-bleed, the patient remains on life-long
warfarin without further episodes of
bleeding or
thrombosis.
Zymogen Protein C concentrate (Ceprotin®, Baxter Deerfield, IL) should be strongly considered for peri-procedural management of any patient with
protein C deficiency and previous
thromboembolism.