Myocardial Infarction in a Patient with Coexisting Protein C Deficiency: A Single Case Report and Systematic Review and Pooled Analysis of Published Case Reports
DOI:
https://doi.org/10.33192/smj.v78i7.281416Keywords:
Hematology, Protein C deficiency, Thrombophilia, Myocardial infarction, ThrombosisAbstract
Objective: To report a case of MI in a patient with PC deficiency and to conduct a systematic review and pooled analysis of published cases to summarize clinical features, laboratory findings, recurrence patterns, and management strategies.
Materials and Methods: A systematic review and pooled analysis of reported cases with concurrent MI and PC deficiency was performed. Literature published through June 2024 was identified by searches of MEDLINE and Embase.
Results: Thirty-three patients, including the present case, were analyzed. Median age at presentation was 37 years (IQR 26.5–44). Traditional atherosclerotic risk factors were reported in 6 patients (18.2%). Recurrent arterial and/or venous thrombosis occurred in 19 patients (57.6%). Median PC activity and antigen levels were 42.8% (IQR 32.3–50.5%) and 44.0% (IQR 39.7–52.2%), respectively. Four distinct PROC mutations were described. Coronary angiography most often showed thrombotic occlusion without clear atherosclerotic disease. Combination anticoagulant and antiplatelet therapy was the most common treatment approach. Active smoking was associated with recurrent thrombosis (odds ratio 6.667, 95% CI 1.047–42.431; p=0.045).
Conclusions: PC deficiency may be associated with MI and a high rate of recurrent thrombosis. Targeted evaluation may be considered in selected MI patients, particularly when coronary angiography shows no significant atherosclerosis.
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