A 44-year-old woman is hospitalized for evaluation and management of an excessively elevated international normalized ratio (INR). She takes warfarin for a throm-boembolic diathesis of 10 years' duration. Her first episode of deep vein thrombosis (DVT) was it 1999 and was idiopathic. Evaluation at that time revealed factor V Leiden heterozygosity. She has had multiple episodes of DVT and a pulmonary embolism in the intervening years. A vena cava filter was placed 5 years ago.
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