DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175745

Deep venous thrombosis in a patient with therapeutic INR for PS deficiency

Motahareh Vamegh, Ahmad Hallak, Wael Abousherif

Abstract


We have reported a rare case of DVT in a 25-year-old patient with a known case of Protein S deficiency with INR within therapeutic index. He was seen in the ED and transferred to the Medical ward after diagnosis in the ED using doppler US. The patient was successfully treated with heparin and warfarin with a higher than usual optimal INR. This case adds to the growing evidence that PS deficiency is one of the rare causes of DVT, and also raises awareness that thrombosis can still occur in the current optimal INR for such patients. This case report necessitates the revision of what should be the optimal INR for patients with Protein S deficiency who develop thrombosis in the current optimal INR.


Keywords


Deep vein thrombosis, Optimal INR, Protein S deficiency, Thrombosis

Full Text:

PDF

References


Hackeng TM, Rosing J. Protein S as cofactor for TFPI. Arterioscler Thromb Vasc Biol. 2009;29:2015-20.

Medscape. Protein S Deficiency: Practice Essentials, Pathophysiology, Epidemiology, 2017. Available at: https://emedicine.medscape.com /article/205582-overview#a6. Accessed 6 Nov 2017.

Schwarz HP, Fischer M, Hopmeier P, Batard MA, Griffin JH. Plasma protein S deficiency in familial thrombotic disease. Blood. 1984;64(6):1297-300.

Godwin, JE. Protein S deficiency, 2017. Available at http://emedicine.medscape.com/article/205582-overview. Accessed November 14 2017.

Joshi A, Jaiswal JP. Deep vein thrombosis in protein S deficiency. J Nepal Med Association. 2010;49(177).

Haines ST. Recommended Therapeutic Range for Warfarin Therapy-ASHP Anticoagulation Service Traineeship, 2002. Available at: https://www.mnhospitals.org/Portals/0/Documents/ptsafety/ade/warfarin-INR-range-duration.pdf

Kuruvilla M, Gurk-Turner C. A review of warfarin dosing and monitoring. Proceedings (Baylor University. Medical Center). 2001;14(3):305.

Medscape. International Normalized Ratio (INR) Targets: Valvular Disease: International Normalized Ratio (INR), 2017. Available at: https://emedicine.medscape.com/article/2172274-overview. Accessed 14 Nov 2017.

Balaban M, Stančić V, Rinčić G, Ledinsky M, Lang N, Grbac L, et al. Recurrent Venous Thrombosis Despite ‘Optimal Anticoagulation Therapy’for Antiphospholipid Syndrome-Could New Oral Anticoagulants Solve the Problem?. Acta Clinica Croatica. 2010;49(4):469-77.

Sallah S, Abdallah JM, Gagnon GA. Recurrent warfarin-induced skin necrosis in kindreds with protein S deficiency. Pathophysiology of Haemostasis and Thrombosis. 1998;28(1):25-30.