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A 30-year old woman comes to your office for evaluation of deep venous thrombi. Last year she developed a lower extremity venous clot. She was on oral contraceptives but has subsequently stopped. She was successfully treated with coumadin for six months. Three weeks ago she developed a femoral venous thrombosis, and now she is again treated with coumadin. Her mother died of a pulmonary embolus, and her aunt on her mother's side had a history of venous thrombosis.
All routine laboratory studies are normal, including the complete blood count, prothrombin time, activated thromboplastin time, and liver function tests. She has a test that is positive for the factor V leiden mutation by polymerase chain reaction (PCR).
What will you recommend to the patient?
(A) Coumadin for another three months
(B) Low-molecular-weight heparin for six months
© Intravenous heparin, then coumadin for six months
(D) Lifelong coumadin
(E) Inferior vena cava filter placement
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e;
as there are further chances to prevent emboli we can use filters
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@spartans1
plz give answer wid explanation
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D) Lifelong coumadin
Explanation:
Hereditary resistance to activated protein C is caused by a gene defect in coagulation factor V. Two highly sensitive and specific diagnostic tests are available: a plasma assay using factor V-deficient plasma as a substrate (APC resistance ratio) and a DNA test (using PCR). This disorder is a relatively mild hypercoagulable state. If risk factors are added (i.e., surgery, estrogens or trauma), thrombosis is more likely. Thirty-two percent of women with thrombosis while taking birth control pills and 59% with deep-venous thrombosis during pregnancy have the factor V mutation. Long-term anticoagulation is indicated in patients with hereditary resistance to activated protein C and with a history of recurrent thromboses or after a single major, unprovoked thrombosis. Many affected homozygotes also require lifelong therapy. This patient is a homozygote, and in addition, she has both a recurrent deep-venous thrombosis, as well as an unprovoked thrombosis. There is no reason to place a venous interruption filter, unless she develops recurrent thrombi while on coumadin.
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many thanks to spartans , you will do great on your exam
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Inferior vena cava filter placement
When you cannot continue anticoagulation, and coumadin and low-molecular-weight heparin are inappropriate. In [PE] pulmonary embolus. ****A vena cava filter will prevent further emboli to the lungs; it is indicated either when a patient has a recurrent embolus while on heparin or when there is a contraindication to heparin, such as life-threatening gastrointestinal or intracranial bleeding
