Recurrent DVT’s and PE’s

Patient: I have a dvt in my lower leg and bilat PE. The clots keep coming back even though i am on coumadin.The clots went away completely at one point and came back.I am dizzy pretty much all day,im tired but cant sleep,i have head pressure and my whole body hurts like i just got beatin.Do you know what blood disorder would cause this to keep happening?

Doctor: You require regular INR monitoring while on Coumadin therapy and target INR is between 2 – 3 for treatment of DVT’s or P or PE’s. However if your INR is within this therapeutic range, and you have recurrent clots you may require a higher target INR level or a vena caval filter insertion. You may also require a thrombophilia screen to determine if you have an hereditary condition that increases the tendency to clot. This screen may include: Prothrombin or homocysteine gene mutations, protein C or S deficiency, antithrombin III deficiency or Factor V Leiden deficiency and referral to a consultant Haematologist for specialised advice.