Coagulation

Question 1

Factor V Leiden Screening

Answer 1

1) a first unprovoked VTE at any age, especially at younger ages, 2) history of recurrent VTE, 3) VTE at unusual sites, or 4) VTE during pregnancy, or associated with the use of hormone replacement therapy or oral contraceptives. Genetic testing may also be considered in individuals with unexplained fetal loss, female smokers <50 years old with an MI or stroke, individuals >50 years old with a first VTE in the absence of malignancy or intravascular device, asymptomatic adult family members of individuals with a factor V Leiden mutation (especially those who are pregnant or considering pregnancy or oral contraceptive use), and children with noncatheter-related unexplained VTE or stroke.

Question 2

Patient with FV Leiden with first thrombotic event

Answer 2

oral anticoagulation should be considered, especially with: 1) recurrent VTE, 2) multiple thrombophilic abnormalities, 3) other VTE risk factors (e.g., obesity, smoking, cancer), or 4) homozygous status for factor V Leiden.20 In heterozygous individuals, indefinite anticoagulation following a first VTE event is not routinely recommended, although it should be considered when other risk factors are present.20 Women who carry the factor V Leiden polymorphism should be counseled to avoid oral contraceptives and smoking.

Question 3

F V Leiden

Answer 3

autosomal dominant - 5% lifetime risk of DVT (low lifetime risk)