Q. Is Xarelto a viable option in patient with heterozygous factor V Leiden and DVT?

Answered by
Dr. Prakash H Muddegowda
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on Oct 03, 2019

Hello doctor,

My girlfriend is 26 and was diagnosed with heterozygous factor V Leiden and heterozygous prothrombin 20210. She is very active, runs half marathons, and works out three to five times a week. She had broken her ankle, and we watched TV for two weeks and noticed some swelling. We took her to the doctor, and she had a DVT. She was also on birth control at the time. We have stopped birth control, and she did a regime of Xarelto.

Now since the doctors have found out, she has these two mutations, they want to put her back on Xarelto for life. Is this a viable option? Can she be safe without the blood thinners? We believe the clot was due to the increase factors (birth control, break, and sedentary life). Do you think she needs blood thinners for life or she can take then at times of increased risk breaks, surgery, pregnancy, etc.?

Dr. Prakash H Muddegowda

Geriatrics Hematology Pathology


Welcome to icliniq.com.

Based on your query, my opinion is as follows,

1. Being positive for factor V Leiden and prothrombin is a considerable risk for thrombosis and is very much prone for thrombus formation in the future. This is very much common in homozygous inheritance individuals.

2. I do agree, OCP (rest could have been the cause. However, having associated other thrombosis risks with a history of thrombus (DVT) at present warrants indefinite anticoagulation therapy.

3. With the mutations in play, blood thinners are the safer choice.

4. However, if she is not keen on starting, in heterozygous patients, single thrombus should not warrant lifetime therapy. However, the risk is high up to eight times, compared to normal individuals. Need to watch for DVT symptoms particularly and if there is another episode in future, with or without OCP or any other factors, lifetime therapy is warranted. If there is another thrombotic episode, I would strongly suggest starting blood thinners for life as thrombus, if not detected early like the present time, can be life-threatening.

5. Being heterozygous at present, with a single episode, at present, with associated possible bleeding risks, blood thinners for life may not be warranted. I hope it helps.

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