Initial management for thrombosis due to Protein C deficiency is...

• A. Warfarin therapy for life
• B. Aspirin therapy alone
• C. Heparin infusion only
• D. Heparin initially, then lifelong oral anticoagulation

Answer: (D)

Protein C deficiency creates a tendency to form clots, so initial management of a thrombosis focuses on rapid anticoagulation followed by long-term protection against recurrence. Heparin works quickly to anticoagulate the patient during the acute event and serves as a bridge to a long-term oral anticoagulant. Starting warfarin alone can briefly worsen the prothrombotic state because protein C, a natural anticoagulant, drops early with warfarin therapy, increasing risk of complications like skin necrosis; using heparin first avoids that problem and ensures safe transition to chronic therapy. Aspirin alone doesn’t adequately prevent venous thrombosis in this setting, and using only heparin wouldn’t provide lasting protection. Hence, begin with heparin and then continue lifelong oral anticoagulation.