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General Medicine

Factor V Leiden

Collin Jones, MD and George Pujalte, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Factor V Leiden is a genetic mutation at the activated protein C (APC) cleavage site on the factor V and Va molecule leading to the most common form of inherited thrombophilia.

  • System...

DIAGNOSIS

HISTORY

  • Previous thrombosis

  • Family history of thrombosis

PHYSICAL EXAM

  • Family history of factor V Leiden mutation

  • Findings suggestive of VTE in any form (DVT, PE, cerebral brail thrombosis): 10–2...

TREATMENT

Only indicated if thrombotic event 

GENERAL MEASURES

  • Like general VTE treatment, patients with factor V Leiden and a first thrombosis should be anticoagulated initially with heparin or low-mol...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

Warfarin use requires periodic (~monthly after initial stabilization) INR measurements, with a goal of 2 to 3 (6)[A]. 

DIET

  • No restrictions

  • Large a...

REFERENCES

1
Rosendaal FR, Koster T, Vandenbroucke JP, et al. High risk of thrombosis in patients homozygous for factor V Leiden (activated protein C resistance). Blood.  1995;85(6):1504–1508. [V...

ADDITIONAL READING

Seligsohn U, Lubetsky A. Genetic susceptibility to venous thrombosis. N Engl J Med.  2001;344(16):1222–1231. [View Abstract on OvidMedline] 

SEE ALSO

Deep Vein Thrombophlebitis 

CODES

ICD10

D68.51 Activated protein C resistance 

ICD9

289.81 Primary hypercoagulable state 

SNOMED

  • 307091009 factor V Leiden mutation (disorder)

  • 307116001 Heterozygous Factor V Leiden mutation

  • 307115002 Ho...

CLINICAL PEARLS

  • Extremely rare in Asian and African populations

  • Asymptomatic patients with factor V Leiden do not need anticoagulation.

  • For pregnant women homozygous for factor V Leiden but no prior his...

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Related Images
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Figure 16-55 IVC UMBRELLA FILTER. A. AP Lumbar. B. Lateral Lumbar. This metallic umbrella fillter is placed in the inferior vena cava to capture emboli from the lower extremities in patients with thrombophlebitis.
Figure 16-55 IVC UMBRELLA FILTER. A. AP Lumbar. B. Lateral Lumbar. This metallic umbrella fillter is placed in the inferior vena cava to ca...
Figure 18-110DEEP VENOUS THROMBOSIS. A. Ultrasound,Lower Limb.Note the thrombus within the femoral vein (arrows). Failure of the vein to collapse from the compression of the ultra sound head confirms the presence of endoluminal thrombus (arrowheads). B. Pulmonary Embolism,Pulmonary CT Angiogram, Axial Chest.Observe the emboliin the pulmonary artery (arrow) and left atrium (arrow). COMMENT:Lower limb ultrasound evaluation is routinely p...
Figure 18-110DEEP VENOUS THROMBOSIS. A. Ultrasound,Lower Limb.Note the thrombus within the femoral vein (arrows). Failure of the vein to co...
Venous thrombosis. The femoral vein has been opened to reveal a large thrombus within the lumen.
Venous thrombosis. The femoral vein has been opened to reveal a large thrombus within the lumen.
FIGURE 24-15 Common sites of venous thrombosis. (A) Superficial thrombophlebitis. (B) Most common form of deep thrombophlebitis. (C and D) Deep thrombophlebitis from the calf to iliac veins.
FIGURE 24-15 Common sites of venous thrombosis. (A) Superficial thrombophlebitis. (B) Most common form of deep thrombophlebitis. (C and D) ...
Figure 13.28. Measurement of the lower extremity circumference. Increase in size is consistent with swelling, which might be due to a deep venous thrombosis.
Figure 13.28. Measurement of the lower extremity circumference. Increase in size is consistent with swelling, which might be due to a deep ...
Schematic of development of thrombus in deep vein
Schematic of development of thrombus in deep vein
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