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Thromb Haemost 1985; 53(02): 249-251
DOI: 10.1055/s-0038-1661286
Original Article
Schattauer GmbH Stuttgart

Defibrination During Warfarin Therapy in a Man with Protein C Deficiency

Robert B Francis Jr.
The Division of Hematology, Dept, of Medicine, Los Angeles Country-University of Southern California Medical Center, Los Angeles, CA, USA
,
William G McGehee
The Division of Hematology, Dept, of Medicine, Los Angeles Country-University of Southern California Medical Center, Los Angeles, CA, USA
› Author Affiliations
Further Information

Publication History

Received 29 November 1984

Accepted 03 February 1985

Publication Date:
18 July 2018 (online)

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Summary

A 57 year old man presented with apparently spontaneous lower extremity deep vein thrombosis and pulmonary embolism. He was treated in conventional fashion with intravenous heparin and oral warfarin. After 4 daily doses of warfarin the prothrombin and proconvertin (P+P) time was within therapeutic range, and heparin was stopped. Over the next six hours complete defibrination occurred, associated with severe bleeding complications. Functional protein C measured after normalization of routine coagulation tests averaged 40% of normal, and was only 3.5% of normal immediately prior to the episode of defibrination. We conclude that the very low functional protein C levels seen immediately prior to defibrination were caused by a combination of pre-existent protein C deficiency and warfarin therapy, and directly predisposed to defibrination once heparin was stopped, despite “therapeutic” warfarin anticoagulation. Exacerbation of intravascular coagulation should be considered a potential prothrombotic effect of warfarin therapy in protein C deficient individuals.

Keywords

Protein C deficiency - Warfarin therapy - Disseminated intravascular coagulatione
 

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