A Compelling Case for the Use of Perioperative Zymogen Protein C for Increased Patient Safety

• Published in: Advances in experimental medicine and biology Vol. 923; p. 15
• Main Authors: Bruley, Duane F, Abdallah, J M, Streiff, M B, McGuire, T W, Bruley, K C, Duncan, M, Duncan, R, Thiessen, E E, White, M, Bruley, Jr, K C, Bruley, S B
• Format: Journal Article
• Language: English
• Published: United States 2016
• Subjects: Aged, 80 and over; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Anticoagulants - economics; Blood Coagulation - drug effects; Blood Coagulation Tests; Cost-Benefit Analysis; Drug Costs; Drug Substitution; Enzyme Precursors - administration & dosage; Enzyme Precursors - adverse effects; Enzyme Precursors - economics; Hernia, Inguinal - surgery; Herniorrhaphy - adverse effects; Humans; Male; Patient Safety; Protein C - administration & dosage; Protein C - adverse effects; Protein C - economics; Protein C Deficiency - blood; Protein C Deficiency - diagnosis; Protein C Deficiency - drug therapy; Protein C Deficiency - economics; Recurrence; Risk Assessment; Risk Factors; Treatment Outcome; Venous Thrombosis - blood; Venous Thrombosis - economics; Venous Thrombosis - etiology; Venous Thrombosis - prevention & control; Warfarin - administration & dosage; Warfarin - adverse effects; Patient safety; Zymogen protein C (ZPC); Optimal dosage; PC deficiency; Surgery
• ISSN: 0065-2598
• DOI: 10.1007/978-3-319-38810-6_2

It is imperative to maintain normal blood flow to provide adequate oxygen supply to specific organs and cells, as well as for the removal of metabolic byproducts. Therefore, any situation that results in blood clotting can injure or kill living tissues. In this paper, we describe a case where a protein C deficient subject who would, by all medical indicators, be at 100 % risk of experiencing thrombophlebitis, deep vein thrombosis, and or lung emboli, is able to escape all pathologies by using perioperative zymogen protein C (ZPC). This protein C deficient patient has a long history of blood clotting, particularly from surgical procedures. The patient is 81 years old and first experienced clotting due to hernia surgery in 1964, when he was hospitalized for 16 days post-surgery with life threatening complications. It was later determined in 1980, after many episodes, that the patient had hereditary protein C deficiency at the 38 % level. In his hernia surgery, perioperative ZPC was used along with accepted anticoagulation procedures with no blood clots or other related side effects occurring. This procedure can greatly benefit protein C deficient patients, and could potentially find use for non-PC deficient patients in surgeries and a variety of other medical treatments. This particular case helps to validate the importance of ZPC in effecting safer surgery in high-risk patients. It also supports the mechanism of ZPC acting as an anticoagulant without causing bleeding. Most importantly, each clinical case study represents a unique combination of surgeon, hematologist, medical staff, and patient functioning as a coordinated team. In this case, smaller amounts of very expensive ZPC achieved safe and efficacious results, which is hugely important for future clinical applications when considering the production cost of ZPC. More studies must be done to establish minimum dosing while achieving safe and efficacious outcomes.