Efficacy of danazol in a patient with congenital protein-S deficiency: paradoxical evidence for decreased platelet activation with increased thrombin generation

M R Ledford, Allan Horton, Amanda Horton, A Horton, Grace Wang, G. Wang, Gang Wang, Maria Brito, M Brito, Miguel Brito, Luís Delgado, Luz Delgado, L Delgado
Thrombosis research · 1997 · vol. 87(5) , pp. 473–482 · doi:10.1016/s0049-3848(97)00163-1 · PMID:9306621 · W2158493451
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This case report details the paradoxical observation of decreased platelet activation alongside increased thrombin generation in a patient with congenital protein S deficiency treated with danazol.

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Abstract

Danazol, a synthetic attenuated anabolic steroid, has been administered for 36 months to a 32 year old male with hereditary Protein S (PS) deficiency who had become non-compliant for warfarin therapy. The patient has an eleven year history of venous thrombosis. Since danazol therapy was initiated, the patient has not experienced a thrombotic event or adverse side-effects. Levels of PS, other inhibitors, fibrinolytic components, and markers for thrombin and platelet activation were measured prior and subsequent to therapy. Following danazol administration, marked and sustained increases were noted in Free Protein S, Antithrombin, and Protein C. Platelet CD62 (P-selectin) positivity which was elevated before therapy, decreased to assay threshold limits within five weeks. Both Prothrombin Fragment 1.2 and thrombin-antithrombin complexes were elevated post danazol therapy indicating continued clearance of generated thrombin. These data suggest that the protective effect provided by danazol in this patient with hereditary PS deficiency, may in large part be due to suppression of platelet activation by thrombin inhibition than simply through elevation of PS.

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MeSH descriptors

Danazol Estrogen Antagonists Platelet Activation Protein S Deficiency Thrombin Adult Anticoagulants Cell Separation Danazol Estrogen Antagonists Fibrinolysis Fibrinolysis Flow Cytometry Humans Male Protein S Deficiency Protein S Deficiency Protein S Deficiency P-Selectin P-Selectin

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