Q: In June 2009 I developed a DVT following routine lab work. About one week after the blood was drawn from my left arm, I noticed the area was swollen, warm and painful. I called my doctor and went to his office. I was sent to the hospital for an ultrasound which confirmed a DVT. This was followed by blood thinning shots in my abdomen for seven days and coumadin tablets.
Blood tests revealed that I have factor V leiden hetrozygote. I no longer take Estrace, Meloxicam, fish oil, a multi vitamin and I eat limited amounts of green food of those high in vitamin K.
The clot has dissolved to allow circulation in the vein but there are remnants left. If the clot is completely dissolved in five more months, I may be able to take an aspirin daily instead of the Coumadin. However, if it is not or I develop another blood clot, I will remain on the medication. I have an excellent doctor and follow his directions explicitly.
I feel truly blessed and know that if I had not developed the clot, I would have continued using the female hormone, Meloxicam, fish oil and a multivitamin and eating my favorite foods (mostly green) and maybe could have had a major event without ever knowing about factor V. I am thankful it is NOT homozygote. Please discuss all the ramifications of factor V.
A: For those readers who may never have heard or factor V Leiden, or who may not fully understand the condition, Factor V (five) Leiden is a mutation of one of the clotting factors in the blood known as factor V that can increase a person’s risk for developing abnormal blood clots that ordinarily appear in the veins. While some individuals may never develop clots, others can and they have the potential to lead to long-term health concerns. While men and women can develop factor V, women are more prone either when taking estrogen or during pregnancy.
The initial symptom, if any appear at all, is, as you have discovered, blood clots. When a clot develops in a deep vein, it is known as DVT or deep vein thrombosis. Clots that form nearer the surface of the skin are known as superficial vein thrombosis or superficial venous thrombophlebitis. Phlebitis (vein inflammation) and thrombophlebitis (vein inflammation with clot formation) can be either deep or superficial. They can present with redness, pain and a warm feeling. Clots that travel to the lungs are known as pulmonary emboli. This condition occurs when a clot breaks free, travels through the right side of the heart and to the lung.
Almost all of us have had a cut at some stage of our lives. A clot forms at the site of injury and stops the bleeding. This is normal. Those individuals with factor V leiden have a mutation that causes the protein to respond much more slowly to deactivation increasing the likelihood of clotting. With this condition, a person either inherits one copy of a defective gene (heterozygous) or in rare instances, two copies with one from each parent (homozygous) that greatly increases the risk of developing clots.
Diagnosis of suspected factor V Leiden can be confirmed either through an activated protein C resistance test or through genetic testing. The genetic testing will also identify whether a person has inherited one or two copies of the gene mutation.
Treatment customarily begins with an anti-coagulant heparin or warfarin combination if a clot is diagnosed. The heparin will probably be discontinued following initial treatment but the warfarin will continue to be prescribed until there are no further problems. At that point, the drug may be discontinued depending on other risk factors. If, however, no blood clots are reported, this method will not be used except in high risk situations. The prescribing physician will then request timely monitoring of lab values to be assured you are receiving the appropriate dosing.
On the home front, patients should lose weight if appropriate, since additional pressure is placed on the legs, they should discontinue smoking, avoid long trips that involve sitting such as with an airplane trip or extended auto trips, and eliminate any estrogen replacement medication. Any young female contemplating the use of an oral contraceptive should speak with her primary care physician or gynecologist prior to use.
Count your blessings you have the knowledgeable caregiver you do. He has kept you well informed and appears to be providing superior service.
