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The influence of family history on recurrence risk in patients with deficiency of antithrombin, protein C or protein S requires study. There is no evidence that heritable thrombophilia should influence the intensity of anticoagulation with heparin or VKAs. In a review of 70 thrombotic events in 57 individuals with antithrombin deficiency, heparin resistance was infrequent and recurrence or extension of thrombosis http://www.selleckchem.com/products/bay-57-1293.html while on treatment was no greater than ordinarily expected in patients treated for venous thrombosis (Schulman & Tengborn, 1992). Coumarin-induced skin necrosis is extremely rare, even in patients with protein C or S deficiency, such that most individuals with protein C or S deficiency do not develop skin necrosis; there is no indication that initiation of oral anticoagulant treatment whilst patients are receiving heparin should be different in patients known to have protein C or S deficiency. The intensity of maintenance therapy with warfarin should not be influenced by laboratory evidence of inherited thrombophilia. There is no evidence that recurrence on oral VKA treatment is more likely in patients with heritable thrombophilia (Kearon et?al, 2008a). Initiation and intensity of anticoagulant therapy following a diagnosis of acute venous thrombosis should be the same in patients with and without heritable thrombophilia (1B). Long-term prospective cohort outcome studies have shown that finding a heritable thrombophilia does not typically predict recurrence (Baglin et?al, 2003; Christiansen et?al, 2005). An analysis of the MEGA study http://www.selleckchem.com/products/Roscovitine.html showed that testing for inherited thrombophilia did not reduce recurrence http://en.wikipedia.org/wiki/Methisazone of venous thrombosis (Coppens et?al, 2008). Systematic reviews of the risk of recurrent venous thromboembolism in patients heterozygous for the F5G1691A mutation indicate a risk of 1��4 and for the F2G20210A 1��2�C1��7 (Ho et?al, 2006; Marchiori et?al, 2007). The authors concluded that the magnitude of the increase in risk was modest and by itself did not justify an extended duration of anticoagulation. In patients with deficiency of a natural anticoagulant (antithrombin, protein C, protein S deficiency) the risk of recurrence is uncertain but relative risks of recurrence appear to be