Diferencia entre revisiones de «Factor V Leiden»
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==Background== | ==Background== | ||
* | *Most common inherited thrombophilia (3-8% of Caucasians) | ||
*Point mutation in | *Point mutation in Factor V making it resistant to cleavage by activated protein C → hypercoagulable state | ||
* | *Heterozygous: 3-8× increased risk of VTE; Homozygous: 50-80× increased risk | ||
*Most individuals with FVL will never | *Most individuals with FVL will never develop a [[DVT|venous thromboembolism (VTE)]] | ||
*'''EM relevance:''' Presents when a provoking factor (OCP use, surgery, immobilization, pregnancy) unmasks the predisposition | |||
==Clinical Features== | ==Clinical Features== | ||
* | *[[DVT]], [[pulmonary embolism]] | ||
*VTE at | *VTE at young age (<50 years) without clear provoking factor | ||
*VTE in | *VTE in atypical locations (mesenteric, cerebral venous sinus) | ||
*Recurrent VTE | |||
*Family history of VTE or known thrombophilia | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*Activated protein C resistance assay — screening test | |||
*Factor V Leiden genetic testing — confirmatory | |||
*'''Do NOT order thrombophilia workup in the acute ED setting''' — anticoagulation and acute illness affect results | |||
*Thrombophilia testing should be deferred to outpatient hematology follow-up | |||
==Management== | ==Management== | ||
*'''Acute VTE:''' Standard anticoagulation per [[DVT]] or [[pulmonary embolism]] guidelines (same as non-FVL patients) | |||
*'''Duration of anticoagulation''' (hematology decision): | |||
**First provoked VTE: 3-6 months | |||
**Unprovoked VTE or recurrent VTE: consider indefinite anticoagulation | |||
*Asymptomatic FVL carriers: no prophylactic anticoagulation; counsel on risk reduction | |||
==Disposition== | ==Disposition== | ||
*Per underlying VTE management | |||
*Ensure hematology follow-up for thrombophilia evaluation after acute treatment | |||
==See Also== | ==See Also== | ||
*[[DVT]] | |||
*[[Pulmonary embolism]] | |||
*[[Coagulopathy (Main)]] | |||
==References== | ==References== | ||
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[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
[[Category:Labs]] | |||
Revisión actual - 06:44 22 mar 2026
Background
- Most common inherited thrombophilia (3-8% of Caucasians)
- Point mutation in Factor V making it resistant to cleavage by activated protein C → hypercoagulable state
- Heterozygous: 3-8× increased risk of VTE; Homozygous: 50-80× increased risk
- Most individuals with FVL will never develop a venous thromboembolism (VTE)
- EM relevance: Presents when a provoking factor (OCP use, surgery, immobilization, pregnancy) unmasks the predisposition
Clinical Features
- DVT, pulmonary embolism
- VTE at young age (<50 years) without clear provoking factor
- VTE in atypical locations (mesenteric, cerebral venous sinus)
- Recurrent VTE
- Family history of VTE or known thrombophilia
Differential Diagnosis
Evaluation
- Activated protein C resistance assay — screening test
- Factor V Leiden genetic testing — confirmatory
- Do NOT order thrombophilia workup in the acute ED setting — anticoagulation and acute illness affect results
- Thrombophilia testing should be deferred to outpatient hematology follow-up
Management
- Acute VTE: Standard anticoagulation per DVT or pulmonary embolism guidelines (same as non-FVL patients)
- Duration of anticoagulation (hematology decision):
- First provoked VTE: 3-6 months
- Unprovoked VTE or recurrent VTE: consider indefinite anticoagulation
- Asymptomatic FVL carriers: no prophylactic anticoagulation; counsel on risk reduction
Disposition
- Per underlying VTE management
- Ensure hematology follow-up for thrombophilia evaluation after acute treatment