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Answer 2
  1. There is no evidence of a hypercoagulable state. Protein C and protein S are regulatory factors that decrease the risk for clotting. Deficiencies of protein C or protein S can increase the risk for clotting. A more common cause of the hypercoagulable state is factor V Leiden mutation. Protein C and protein S exert their effects via factor V. When the factor V Leiden mutation is present, this process does not occur. The case patient has low levels of protein C and protein S. However, one of the keys in obtaining laboratory measurements is understanding factors that invalidate the tests. Levels of protein C and protein S decrease in patients receiving warfarin; therefore, the low levels that are obtained are meaningless. The only tests of significance are the genetic tests, because the DNA is unchanged by warfarin. Prothrombin 20210 is another mutation that can lead to hypercoagulability, but it is not detected in this case.

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