From the Guidelines
Yes, an ongoing pulmonary embolism (PE) can lower protein C levels. During an acute PE, the body's coagulation system becomes activated, consuming clotting factors and natural anticoagulants like protein C 1. This consumption occurs because protein C is utilized in the body's attempt to break down the abnormal clots. Additionally, inflammatory responses triggered by the PE can affect liver function, potentially reducing protein C production since it's synthesized in the liver.
Key Considerations
- The activation of the coagulation system and the consumption of protein C can lead to a temporary decrease in protein C levels during an active PE.
- Inflammatory responses triggered by the PE can also affect liver function, potentially reducing protein C production.
- Certain anticoagulants, particularly vitamin K antagonists like warfarin, can also artificially lower protein C levels, further complicating interpretation during active treatment for PE 1.
Clinical Implications
- For accurate assessment of baseline protein C levels, it's recommended to wait until at least 2-3 months after the acute thrombotic event and completion of anticoagulation therapy.
- The management of PE should follow the latest guidelines, which recommend initiation of anticoagulation without delay in patients with high or intermediate clinical probability of PE, while diagnostic workup is in progress 1.
- The choice of anticoagulant should be based on the patient's clinical profile and the presence of any contraindications, with a preference for non-vitamin K antagonist oral anticoagulants (NOACs) over vitamin K antagonists (VKAs) in eligible patients 1.
From the Research
Ongoing Pulmonary Embolism and Protein C Levels
- There is no direct evidence in the provided studies to suggest that an ongoing pulmonary embolism (PE) lowers protein C levels 2, 3, 4, 5, 6.
- The studies primarily focus on the treatment and management of PE, including the use of anticoagulants such as rivaroxaban and warfarin, and their efficacy and safety in real-world clinical practice 3, 4.
- Protein C is not mentioned in any of the provided studies, and therefore, there is no information available to determine the effect of an ongoing PE on protein C levels.
- Further research would be necessary to investigate the relationship between ongoing PE and protein C levels, as the current evidence does not provide any insight into this topic 2, 3, 4, 5, 6.