# Persistent Peril: Recurrent Deep Vein Thrombosis and Pulmonary Embolism in a Patient With Protein S Deficiency Despite Optimal Anticoagulation Therapies

## TL;DR

A patient with protein S deficiency continues to suffer from recurring blood clots despite following standard treatment guidelines.

## Contribution

This case report highlights the difficulty in managing VTE in patients with protein S deficiency, even with optimal anticoagulation therapies.

## Key findings

- The patient experienced recurrent DVT and PE despite guideline-directed anticoagulation.
- Current medical treatments failed to prevent hospital readmissions due to persistent VTE episodes.

## Abstract

The clotting system has evolved as an adaptive mechanism to prevent blood loss during vascular damage. However, the intricate nature of the clotting cascade and the complexities of human life can sometimes lead to the unnatural activation of this delicate cascade. This can result in blood clot formation within the cardiovascular system, contributing to a wide range of pathological conditions. Abnormal intravascular coagulation most commonly occurs in the deep veins of the lower extremities, and can emboli to other organs, hence, it is termed "venous thromboembolism" (VTE).

In this report, we introduce a challenging case of VTE that poses a dilemma for current medical management. The patient with possible protein S deficiency underwent various guideline-directed medical treatments, yet experienced recurrent VTE episodes, including deep vein thrombosis (DVT) and pulmonary embolism (PE), leading to hospital readmissions. This case report sheds light on our challenges in effectively treating VTE.