Protein C and protein S levels can be accurately determined within 24 hours of diagnosis of acute venous thromboembolism

In the 50% of cases of acute idiopathic venous thromboembolism, laboratory testing for inherited causes is often performed. Most physicians are under the impression that assays for protein C and protein S should not be measured at the time of diagnosis because of a high false positive rate. We performed a prospective cohort study from two outpatient thromboembolism clinics on consecutive patients with an objectively confirmed diagnosis of first acute idiopathic venous thromboembolism. Assays for protein C and protein S were performed prior to the initiation of oral anticoagulation therapy and within 24 h of diagnosis of venous thromboembolism. Abnormal results were repeated when patients discontinued oral anticoagulant therapy. Of 253 patients tested for both protein C and protein S, 229 (91%; 95% confidence interval 87-94%) were negative and 484 of 508 (95%) tests were normal. Of the 24 initial abnormal results, 21 were repeated and 10 (48%; 95% confidence interval 26-70%) were still abnormal. Overall, 97.8% of initial protein C and protein S results were accurate. If protein C and protein S are measured at the time of diagnosis of acute venous thromboembolism, the majority of the results will be normal and false positives are uncommon.