acenocoumarol and Disseminated-Intravascular-Coagulation

We describe a 57-year-old woman with homozygous protein C deficiency and mild thrombotic manifestations consisting of three spontaneous distal deep vein thromboses occurring after the age of 45. Previous surgery and pregnancies had been uneventful. Low but detectable protein C antigen and activity levels (both 20%) were discovered on the occasion of skin necrosis induced by oral anticoagulation. This therapy was interrupted because of skin necrosis and several episodes of disseminated intravascular coagulation (DIC) at the initiation of treatment despite a cautious protocol. No recurrent thromboembolic event has occurred in our patient using prophylactic doses of low molecular weight heparin for 24 months. New therapeutic approaches might be the administration of low molecular weight heparin or oral anticoagulation associated with protein C replacement in the induction period. This case reflects the variability of expression of protein C deficiency as well as the potential hazards of antivitamin K anticoagulation in this disorder.

Topics: Acenocoumarol; Administration, Oral; Age Factors; Blood Coagulation Disorders; Contraindications; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Female; Genetic Predisposition to Disease; Heparin; Homozygote; Humans; Middle Aged; Necrosis; Protein C Deficiency; Skin; Skin Diseases; Thrombophlebitis; Warfarin

Topics: Acenocoumarol; Administration, Oral; Adult; Anticoagulants; Clinical Trials as Topic; Disseminated Intravascular Coagulation; Drug Evaluation; Glycoproteins; Humans; Male; Protein C; Protein S; Pulmonary Embolism; Thrombophlebitis

Topics: Acenocoumarol; Aged; Anticoagulants; Disseminated Intravascular Coagulation; Female; Humans

A patient with viral hepatitis in the third trimester of pregnancy is described. She developed acute hepatic failure in the postpartum period which was associated with evidence of intravascular coagulation. Following therapy with heparin and fresh-frozen plasma, the patient made a dramatic recovery. Hepatitis developed during the puerperium may predispose to pathological intravascular coagulation and hepatocellular necrosis may thereby be perpetuated.

Topics: Acenocoumarol; Acute Disease; Adult; Alanine Transaminase; Alkaline Phosphatase; Bilirubin; Blood Platelets; Disseminated Intravascular Coagulation; Female; Fibrin; Fibrinogen; Heparin; Hepatitis A; Humans; Necrosis; Plasma; Postpartum Period; Pregnancy; Pregnancy Complications, Infectious; Time Factors