title: Pregnancy-associated venous thromboembolism in combined heterozygous factor V Leiden and prothrombin G20210A mutations.
abstract: BACKGROUND
  Pregnancy and puerperium raise the risk of thromboembolic events, and these risks are increased in women who are carriers of thrombophilia factors. Prothrombin (FII) G20210A and factor V Leiden heterozygous mutations are associated with moderate risk of thrombosis. The association of these thrombophilic conditions is very rare in pregnancy, and the real risk of thrombosis is unknown.
  
  
  METHODS
  We describe a case of a pregnant woman who was found to be carrier of heterozygous factor V Leiden and prothrombin (FII) G20210A mutations. Five years before pregnancy she had had an episode of extensive deep venous thrombosis in the ileofemoral region, while using hormonal contraceptives. Anticardiolipin antibody (ACA), lupus anticoagulant and deficiencies of protein C, protein S and antithrombin III were evaluated by means of enzyme-linked immunosorbent assay (ELISA), dilute Russell Viper Venom time (dRVVT), coagulometric and chromogenic methods. Deoxyribonucleic acid (DNA) was amplified using the polymerase chain reaction (PCR) to study the factor V Leiden and G20210A mutations in the prothrombin gene and C677T mutation in the methylene tetrahydrofolate reductase (MTHFR) gene. In the sixth week of her first pregnancy, she developed another episode of deep venous thrombosis in the femoropopliteal veins of the right leg. She was treated with low-molecular weight heparin (nadroparin) until parturition (0.3 ml or 2,850 UI/day). The pregnancy evolved without any significant obstetric morbidity. The patient delivered a healthy baby by cesarean section. During the puerperium, she used prophylactic doses of nadroparin for (0.3 ml or 2,850 UI/day) six weeks and had no complications. We suggest that women who have an association of thrombophilia factors and a prior episode of venous thromboembolism must have antepartum anticoagulation management using unfractioned or low-molecular weight heparin and postpartum management using low-molecular weight heparin or oral anticoagulants. Anticoagulation is recommended during pregnancy because the real magnitude of the risk of major and life-threatening thromboembolic events in these women is unknown.
authors.affiliation: Department of Gynecology and Obstetrics, Universidade Estadual de Campinas, Rua Alexander Fleming 101, CEP 13084-881 Campinas, São Paulo, Brazil.
authors.forename: Egle
authors.initials: E
authors.lastname: Couto
authors.forename: Marcelo Luís
authors.initials: ML
authors.lastname: Nomura
authors.forename: Ricardo
authors.initials: R
authors.lastname: Barini
authors.forename: João Luiz
authors.initials: JL
authors.lastname: Pinto e Silva
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D005165:Factor V / Q000235:genetics*; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009154:Mutation; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000235:genetics*; D011516:Prothrombin / Q000235:genetics*; D012307:Risk Factors; D013923:Thromboembolism / Q000188:drug therapy / Q000235:genetics*; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis / Q000235:genetics*
chemical_list: D000925:Anticoagulants; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin; D006493:Heparin