Successful Warfarin Anticoagulation Despite Protein C Deficiency and a History of Warfarin Necrosis (1986)

Brief Reports1 May 1986Successful Warfarin Anticoagulation Despite Protein C Deficiency and a History of Warfarin NecrosisN. PETER ZAUBER, M.D., MICHAEL W. STARK, M.D.N. PETER ZAUBER, M.D., MICHAEL W. STARK, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-104-5-659 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptProtein C deficiency is an autosomal-dominant disorder associated with recurrent thromboembolism (1). Prevention of the thromboembolic problems requires long-term anticoagulation, but the initiation of oral anti-coagulation therapy in patients with protein C deficiency may be complicated by skin necrosis (2). We present the case of a patient with protein C deficiency for whom anti-coagulation treatment with warfarin was successful, despite prior warfarin necrosis.A 44-year-old man of Greek ancestry developed a left femoral artery thrombosis in 1981 after myelography. He was placed on treatment with warfarin without difficulty and continued the therapy for 8 months. In 1982 he developed right...References1. GRIFFIN J, EVATT B, ZIMMERMAN T, KLEISS A, and WIDEMAN C. Deficiency of protein C in congenital thrombotic disease. J Clin Invest. 1981;68:1370-3. CrossrefMedlineGoogle Scholar2. BROEKMANS A, BERTINA R, LOELIGER E, HOFMANN V, and KLINGEMANN H. Protein C and the development of skin necrosis during anticoagulant therapy [Letter]. Thromb Haemost. 1985;49:251. Google Scholar3. MARLAR R, KLEISS A, and GRIFFIN J. Mechanism of action of human activated protein C, a thrombin-dependent anticoagulant enzyme. Blood. 1982;59:1067-72. CrossrefMedlineGoogle Scholar4. ESMON C and OWEN W. Identification of endothelial cell cofactor for thrombin-catalyzed activation of protein C. Proc Natl Acad Sci USA. 1981;78:2249-52. CrossrefMedlineGoogle Scholar5. WALKER F. Regulation of activated protein C by a new protein: a possible function for bovine protein S. J Biol Chem. 1980;255:5521-4. CrossrefMedlineGoogle Scholar6. EPSTEIN D, BERGUM P, and RAPAPORT S. Kinetics of protein C depression after Coumadin administration [Abstract]. Circulation. 1983;68(4 pt 2):III-316. Google Scholar7. DAVIS C, WILEY W, and FAULCONER R. Necrosis of the female breast complicating oral anticoagulant treatment. Ann Surg. 1972;175:647-56. CrossrefMedlineGoogle Scholar8. HORELLOU M, CONARD J, BERTINA R, and SAMAMA M. Congenital protein C deficiency and thrombotic disease in nine French families. Br Med J[Clin Res]. 1984;289:1285-7. CrossrefMedlineGoogle Scholar9. HORN J, DANZIGER L, and DAVIS R. Warfarin-induced skin necrosis: report of four cases. Am J Hosp Pharm. 1981;38:1763-8. MedlineGoogle Scholar10. SAMAMA M, HORELLOU M, SORIA J, CONARD J, and NICOLAS G. Successful progressive anticoagulation in a severe protein C deficiency and previous skin necrosis at the initiation of oral anticoagulant treatment [Letter]. Thromb Haemost. 1984;51:132-3. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: N. PETER ZAUBER, M.D.; MICHAEL W. STARK, M.D.Affiliations: St. Barnabas Medical Center Livingston, New Jersey PreviousarticleNextarticle