A 69year-old male with hypertension and a remote history of venous thromboembolism was referred to general hematology clinic for recommendations regarding anticoagulation management for an upcoming elective surgery. The patient had initially been diagnosed with a left peroneal vein thrombosis in the 1980’s in the setting of one week of immobilization following trauma to the left Achilles tendon. He was tested for heritable thrombophilias revealing a heterozygous Factor V Leiden mutation, and was subsequently started on warfarin with a plan for indefinite therapy.