Pt in her 70s with past dvt, now off of coumadin, (warfarin) but with slightly high protein c level. do i need to anti-coag, further testing?

No-Sigle DVT/Active: If DVT was Post Op or other trigred events like driving/Flying/long distance, Can stop the Coumadin (warfarin) after treating for 3 to 6 months. ( no HRT?) If there are co morbid conditions like Physical disability and recurrent DVT, or Smoker: Yes Needs long term Rx. If No risk factors and can take ASA, it is an option. Now Xeralto can be an option instead of Coumadin (warfarin). Monitor Protein C and S level.

Malignancy: Past or present will make the patient a candidate for anticoagulation indefinitely with low molecular weight heparin, ideally. Unsure about the use of protein C and or S. Bleeding history and risk should be also weighed in. Ultimately, a thorough discussion and aligning treatment to patient's immediate goals of care should suffice.

Maybe: How long was the DVT and the treatment? If patient is asymptomatic and has no other risk factors like autoimmune diseases, cancer, immobility, other vasculitides, may not need to treat. If risks are high, may want to consider the newer agents (if not fall or dementia risk) to make life easier.

Need more history: More history is needed to define the long term probability of reoccurence of DVT in this patient. A mild protein C elevation may/may not be significant.

Anticoag Guidelines: Questions need to be answered. How long ago was her DVT? Was there a reason for the DVT? Any current risk factors for clot formation? The attached link is a nice summary of the recent Ninth Edition of the American College of Chest Physicians Guidelines on Outpatient Management of Anticoagulation Therapy which should aid in guiding any further anticoag w/u or antcoag treatment if needed http://www.aafp.org/afp/2013/0415/p556.html

Doubt protein C...: Would continue work up for other hypercoagulability factors, Protein S, Factor V Leydin, Homocysteine, Lp(a), PAI-1, Prothrombin 20210A mutatation and Lupus anticoagulant. Protein C is only pro-coagulant if it is low, not high. Also depends on other risk factors; BCP's, prolonged air or car travel, injury, etc.

Informed consent: The question would be how much at risk is she to have another blood clot verses the risk of anti coagulation. Decision should probably be made as a shared decision after discussion with patient. One solution would to simply out her on a daily low dose aspirin. Good question!

No: No. No further treatment would be needed at this time. First of all thrombophilia testing would not be warrented in a 70 year old patient with a history of a single event without further support such as a strongly suggestive family history. In addition, an elevated protein C level is not a risk factor for thromboembolic disease.

Depends: On the reason she had the DVT in the first. If the DVT is due to post surgery or acute immobilization that has resolved then there will be no need for continued warfarin. Due to her age at first DVT doubt deficiency of anticoagulant proteins. If DVT is recurrent or presence CA or other autoimmune or vascular disease the long DVT prophylaxis is indicated