CASE REPORTSMultiple thrombotic sources and embolic events at arterial sites in a patient with protein-C deficiencyKulahcioglu, Seyhmus; Ayturk, Mehmet; Sari, MunevverAuthor Information Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey Correspondence to Mehmet Ayturk, MD, Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Research and Education Hospital, Denizer Caddesi, Cevizli Kavsagi, Kartal, 34865 Istanbul, Turkey Tel: +90 5425761426; fax: +90 2164596321; e-mail: [email protected] Received 7 May, 2021 Revised 25 June, 2021 Accepted 30 June, 2021 Blood Coagulation & Fibrinolysis: December 2021 - Volume 32 - Issue 8 - p 607-610 doi: 10.1097/MBC.0000000000001063 Buy Metrics Abstract Protein-C deficiency causes a thrombophilic environment in circulation. Although venous thromboembolism is the most common presentation, arterial events are rare. A 45 year-old woman with protein-C deficiency presented with multiple thromboembolic events including bilateral renal infarct and inferior ST-elevation myocardial infarction 3-days after coronary angiography via femoral approach which were normal coronary arteries. Computed tomographic angiography and transesophageal echocardioraphy displayed multiple thrombi sources including left atrium, left subclavian artery, sinus valsalva and descending aorta. Unfractionated-heparin and tissue plasminogen activator infusion were given. Although regression in ST-segment elevation and chest pain, no reduction in sizes of left atrial and aortic thrombus was observed by imaging modality. The patient refused surgical removal of thrombi, then warfarin therapy was planned. In patients with congenital thrombophilia and history of thromboembolism, anticoagulant treatment should be carefully managed during percutaneous diagnostic and interventional treatments and they should be performed by radial approach without interruption of anticoagulants. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.