Protein C and protein S deficiency in acute ischemic stroke


  • สุภาวี แสงบุญ ภาควิชาอายุรศาสตร์ คณะแพทยศาสตร์ มหาวิทยาลัยธรรมศาสตร์


protein C, protein S, ischemic stroke


Hereditary protein C or protein S deficiency is associated with venous thromboembolism also increased risk of arterial thromboembolic events at a young age. In patients with thromboembolic disease, transient protein C and protein S deficiency occur due to consumption of both factors. Abnormal Protein C and protein S results determined within 24 hours of acute thromboembolic events need to be confirmed but a normal result effectively rules out deficiency with only one test.


Bagot CN, Arya R. Virchow and his triad: a question of attribution. British journal of haematology. 2008;143(2):180-90.

Brouwer JL, Veeger NJ, Kluin-Nelemans HC, van der Meer J. The pathogenesis of venous thromboembolism: evidence for multiple interrelated causes. Annals of internal medicine. 2006;145(11):807-15.

Chuansumrit A, Jarutwachirakul W, Sasanakul W, Rurgkhum S, Kadegasem P, Kitpoka P, et al. Absence of factor V Arg306--Thr and low factor V Arg306-
>Gly mutation prevalence in Thai blood donors. The Southeast Asian journal of tropical medicine and public health. 2004;35(2):450-2.

Angchaisuksiri P, Pingsuthiwong S, Aryuchai K, Busabaratana M, Sura T, Atichartakarn V, et al. Prevalence of the G1691A mutation in the factor V gene (factor V Leiden) and the G20210A prothrombin gene mutation in the Thai population. American journal of hematology. 2000;65(2):119-22.

Angchaisuksiri P, Atichartakarn V, Aryurachai K, Archararit N, Rachakom B, Atamasirikul K, et al. Risk factors of venous thromboembolism in thai
patients. International journal of hematology. 2007;86(5):397-402.

Knoebl PN. Severe congenital protein C deficiency: the use of protein C concentrates (human) as replacement therapy for life-threatening bloodclotting
complications. Biologics : targets & therapy. 2008;2(2):285-96.

Goldenberg NA, Manco-Johnson MJ. Protein C deficiency. Haemophilia : the official journal of the World Federation of Hemophilia. 2008;14(6):1214-21.

Khan S, Dickerman JD. Hereditary thrombophilia. Thromb J. 2006;4:15.

ten Kate MK, van der Meer J. Protein S deficiency: a clinical perspective. Haemophilia : the official journal of the World Federation of Hemophilia.

Makris M. Thrombophilia: grading the risk. Blood. 2009;113(21):5038-9.

Mahmoodi BK, Brouwer JL, Veeger NJ, van der Meer J. Hereditary deficiency of protein C or protein S confers increased risk of arterial thromboembolic
events at a young age: results from a large family cohort study. Circulation. 2008;118(16):1659-67.

Tosetto A, Ruggeri M, Castaman G, Rodeghiero F. Inherited abnormalities of blood coagulation in juvenile stroke. A case-control study. Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis. 1997;8(7):397-402.

De Lucia D, d’Alessio D, Pezzella S, Maisto G, Di Mauro C, Marotta R, et al. A hypercoagulable state in activated protein C resistant patients with ischemic stroke. International journal of clinical & laboratory research. 1998;28(1):74-5.

Mayer SA, Sacco RL, Hurlet-Jensen A, Shi T, Mohr JP. Free protein S deficiency in acute ischemic stroke. A case-control study. Stroke; a journal of cerebral
circulation. 1993;24(2):224-7.

D’Angelo A, Vigano-D’Angelo S, Esmon CT, Comp PC. Acquired deficiencies of protein S. Protein S activity during oral anticoagulation, in liver disease,
and in disseminated intravascular coagulation. Journal of Clinical Investigation. 1988;81(5):1445-54.

Comp PC, Doray D, Patton D, Esmon CT. An abnormal plasma distribution of protein S occurs in functional protein S deficiency. Blood. 1986;67(2):504-8.

Bushnell CD, Goldstein LB. Diagnostic testing for coagulopathies in patients with ischemic stroke. Stroke; a journal of cerebral circulation. 2000;31(12):3067-78.

Minuk L, Lazo-Langner A, Kovacs J, Robbins M, Morrow B, Kovacs M. Normal levels of protein C and protein S tested in the acute phase of a venous
thromboembolic event are not falsely elevated. Thrombosis Journal. 2010;8:10-.

Mannucci PM, Vigano S. Deficiencies of protein C, an inhibitor of blood coagulation. Lancet (London, England). 1982;2(8296):463-7.

Tripodi A, Salerno F, Chantarangkul V, Clerici M, Cazzaniga M, Primignani M, et al. Evidence of normal thrombin generation in cirrhosis despite abnormal conventional coagulation tests. Hepatology (Baltimore, Md). 2005;41(3):553-8.

Marlar RA, Kleiss AJ, Griffin JH. Mechanism of action of human activated protein C, a thrombindependent anticoagulant enzyme. Blood. 1982;59(5):1067-72.

Marlar RA, Endres-Brooks J, Miller C. Serial studies of protein C and its plasma inhibitor in patients with disseminated intravascular coagulation. Blood. 1985;66(1):59-63.

Comp PC, Thurnau GR, Welsh J, Esmon CT. Functional and immunologic protein S levels are decreased during pregnancy. Blood. 1986;68(4): 881-5.

Rovinsky JJ, Jaffin H. CARDIOVASCULAR HEMODYNAMICS IN PREGNANCY. I. BLOOD AND PLASMA VOLUMES IN MULTIPLE PREGNANCY. American journal of obstetrics and gynecology. 1965;93:1-15.

Hytten F. Blood volume changes in normal pregnancy. Clinics in haematology. 1985;14(3):601-12.

Boerger LM, Morris PC, Thurnau GR, Esmon CT, Comp PC. Oral contraceptives and gender affect protein S status. Blood. 1987;69(2):692-4.

Vigano D’Angelo S, Comp PC, Esmon CT, D’Angelo A. Relationship between protein C antigen and anticoagulant activity during oral anticoagulation
and in selected disease states. The Journal of clinical investigation. 1986;77(2):416-25.




How to Cite

แสงบุญ ส. Protein C and protein S deficiency in acute ischemic stroke. J Thai Stroke Soc [Internet]. 2019 Feb. 14 [cited 2024 Jul. 18];15(3):147-52. Available from:



Original article