Thrombotic

A 25 year old man presents for further workup of an episode of venous thromboembolism.

He developed deep vein thrombosis (DVT) of the left lower limb approximately 4 months ago. Prior to this, he had been sitting in one place for 12 hours, during an airplane flight.

At that time, multiple investigations were performed, including a complete blood count, peripheral blood smear, and liver and renal profiles. No obvious cause for the thrombotic episode could be discerned.

He was then started on heparin and warfarin, with the former discontinued once his INR reached satisfactory levels. The latter was continued for 3 months in total, and stopped 1 month ago.

There is no family history of thrombotic disorders, and he was apparently healthy earlier, with unremarkable medical, surgical, and drug histories.

Select Relevant Investigations
Complete Blood Count + Liver Profile

Performed

The complete blood count and liver profile are both within normal parameters.
Coagulation Profile

Performed

PT: 13 sec (11-13.5)
INR: 0.9 (0.8-1.1)
aPTT: 36 sec (28-38)
TT: 16 sec (15-19)
ANA + Antiphospholipid Abs

Performed

ANA: 0.3 U/L (< 1.0)
Lupus anticoagulant: negative
Anticardiolipin antibodies: negative
Anti-β2-glycoprotein-I antibodies: negative
Genetic Thrombophilia Screen

Performed

Protein C Activity: 32% of normal
Protein S activity: normal
Antithrombin III activity: normal
Activated Protein C resistance ratio: within normal range
Factor VIII concentration: normal
Fibrinogen concentration: normal
Serum Homocysteine levels: normal
FII G20210A mutation analysis: negative

Select Relevant Management
Lifelong Warfarin Therapy
Lifelong Aspirin Therapy
Screen Family Members
Prophylactic FFP each month