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Fernando

Contact sports and Warfarin

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Hi all,

I am new to this forum and trying to get to terms with a newly found protein S deficiency on my 14 year old son due to a mutation, not genetic. He has been put on warfarin and leads a "normal" life. The issue is that he is on a Rugby scholarship in one of the top schools in UK and the sport is an important part of his life. He has been looked after by a top Singaporean doctor and I still fly him to see him sporadically. Unfortunately the doctor as good as he is, is not sympathetic to contact sports. Reason why I look for answers elsewhere to explore the possibility of getting him back to the pitch. His condition was discovered because he developed a clot in the portal vein, but it looks that it took time to grow as the first indications of low haemoglobin showed up 2 years before they discovered the clot. Can anyone point me in the direction of someone that can dose him in such a way that the risks of bleeding are minimised? Anyone with this condition practices contact sports? I don't expect MMF fighters to do this but someone exposed to random injuries due to usual hits in contact sports.

Any help greatly appreciated

Fernando 

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It is unusual for protein s deficiency to trigger a thrombosis event at his age, so there may be other risk factors. Without the familial testing to confirm the diagnosis it may help to run the screening process again. For example protein s levels are naturally reduced after a clotting event, and warfarin reduces them too, so you need to be clear of both to get a reliable natural reading. Factor V Leiden is often misdiagnosed as Protein S Deficiency.

Regardless of the cause, if he has only had one clot then normal procedure is for warfarin for 3 months, then to come off anticoagulants. This would allow him to play contact sports as normal. However if he has an injury, is laid up, has a broken bone etc, then there is a higher risk of another clot unless he receives anticoagulants. A second clot would put him on anticoagulants for life.

Apart from checking the screening I would suggest contacting a trade body for rugby and asking for support from their medical advisors. There may be professional players dealing with the same issue already.

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Thank you very much for your reply, I agree that we need to run further tests, I have contacted specialists in Italy and Spain as I discovered that they are very active in those countries regarding PSD. The clot might have taken up to two years to develop, and it was dissolved in a bit over a week, after a month there was no sign of it. We will alter the  treatment during summer and will keep you posted. Also read about mutations generated by chicken pox might trigger a drop as in protein s well.

Thanks for the help

 

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I thought your concern was about his sporting career? Protein S Deficiency is either hereditary or acquired. Identifying the finer details of what type of PSD your son may have doesn’t change anything relating to his sports activities. Doctors will roll all causes under the blanket heading of thrombosis and treat him the same as any other person with thrombosis, so you don’t need specialists. The focus should now be on prevention and adjusting that to his lifestyle (sports activities).

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Hi James and thanks again, that's what I meant, looking for alternatives to warfarin treatment that might be friendlier to contact sports, and the active life of a boy in boarding school...that's why I'd like to find second opinions towards the treatment alternatives and prevention

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