ABSTRACT
A 46-year-old man is seen in the accident and emergency (A&E) department with central chest pain. The pain settles spontaneously but there are ischaemic changes on the ECG and he is started on aspirin. The cardiologists wish to carry out an angiogram but have noticed some abnormalities on the coagulation screen. The patient is a heavy smoker but has no other medical history. He is aware that his sister has some sort of blood disorder that was diagnosed following a pulmonary embolism (PE) when she was aged 32. She is on lifelong warfarin.
