{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:10:17Z","timestamp":1756379417699,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,10,30]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p>Protein C deficiency is a hereditary disorder that increases the risk of thrombotic events but has unclear effects on rotational thromboelastometry (ROTEM) analysis. A man in his 60s with a history of protein C deficiency and multiple thrombotic events underwent inferior vena cava (IVC) filter removal, iliocaval thrombectomy and infrarenal IVC placement for IVC-related complete iliocaval and common femoral vein thromboses. A ROTEM analysis showed normal coagulation in NATEM and EXTEM and only a slight shortening in A10 and A20 in INTEM, which was unexpected given his diagnosis of protein C deficiency. Normal results indicate that there is complexity and variability of coagulation to maintain a balanced state even in individuals with underlying coagulation disorders.<\/jats:p>","DOI":"10.1136\/bcr-2024-262718","type":"journal-article","created":{"date-parts":[[2024,11,17]],"date-time":"2024-11-17T21:52:05Z","timestamp":1731880325000},"page":"e262718","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Unexpected normal ROTEM results in protein C deficiency with IVC thrombosis"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0418-3548","authenticated-orcid":false,"given":"Rachel Seunah","family":"Kim","sequence":"first","affiliation":[{"name":"Anesthesiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4638-4161","authenticated-orcid":false,"given":"Uzung","family":"Yoon","sequence":"additional","affiliation":[{"name":"Anesthesiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,11,17]]},"reference":[{"key":"2025082803313168000_17.11.e262718.1","doi-asserted-by":"crossref","DOI":"10.1007\/s44313-024-00018-6","article-title":"Assessment of the phenotypic severity of hemophilia A: using rotational thromboelastometry (ROTEM) and APTT-clot waveform analysis","volume":"59","author":"Gupta","year":"2024","journal-title":"Blood Res"},{"key":"2025082803313168000_17.11.e262718.2","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s12185-023-03659-y","article-title":"Comprehensive comparison of global coagulation assays to differentiate lupus anticoagulant from acquired hemophilia A in patients with prolonged APTT","volume":"118","author":"Chikasawa","year":"2023","journal-title":"Int J Hematol"},{"key":"2025082803313168000_17.11.e262718.3","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/MBC.0b013e328309044b","article-title":"Whole blood coagulation assessment using rotation thrombelastogram thromboelastometry in patients with acute deep vein thrombosis","volume":"19","author":"Spiezia","year":"2008","journal-title":"Blood Coagul Fibrinolysis"},{"key":"2025082803313168000_17.11.e262718.4","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/TA.0000000000001618","article-title":"The rate of deep vein thrombosis doubles in trauma patients with hypercoagulable thromboelastography","volume":"83","author":"Brill","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082803313168000_17.11.e262718.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-014-0549-2","article-title":"Rotational thromboelastometry predicts thromboembolic complications after major non-cardiac surgery","volume":"18","author":"Hincker","year":"2014","journal-title":"Crit Care"},{"key":"2025082803313168000_17.11.e262718.6","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2022.991675","article-title":"The impact of direct oral anticoagulants on viscoelastic testing - 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