A 28-year-old man presents with acute left leg pain and swelling. Vital signs: BP 118/76, HR 92, RR 16, temp 37°C, SpO2 98% on room air. Duplex ultrasound confirms left femoral DVT. Labs show protein C activity 55% (normal 70-150%); D-dimer elevated at 2.8 μg/mL. Family history significant for thrombosis in his mother at age 35. He denies recent immobility, surgery, or malignancy. Which of the following should be considered before initiating anticoagulation therapy?
- A)Protein C deficiency is a contraindication to all anticoagulation
- B)Protein C levels must reach 100% before any anticoagulation
- C)Protein C deficiency may worsen with warfarin monotherapyGABARITO
- D)Factor V Leiden must be ruled out before treatment
- E)Vitamin K should be given to increase protein C levels
Explicação
Protein C deficiency is a hypercoagulable state. When warfarin is initiated, factors II, VII, IX, and X decrease faster than protein C (short half-life), creating transient hypercoagulability and skin necrosis risk. Bridging with heparin is essential. Ver explicação completa e trilha adaptativa →