A 45-year-old paraplegic patient suffered his first and only deep venous thrombosis (DVT) six months ago and has been placed on warfarin (Coumadin) for life. He is a smoker. How long must he take Coumadin?
—Ivanka Vassileva, MD, Lawton, Okla.
It is reasonable to continue warfarin therapy indefinitely. In this age group, testing for thrombophilia markers (i.e., factor V Leiden, prothrombin 20010A, antithrombin III, proteins C and S activities, homocysteine, antiphospholipid antibodies, lupus anticoagulant) is worthwhile. The presence of one or more markers may warrant maintenance of a somewhat higher international normalized ratio.
—Dennis K. Galanakis, MD (112-14)