title: Mesenteric vein thrombosis in a patient heterozygous for factor V Leiden and G20210A prothrombin genotypes.
abstract: Mesenteric venous thrombosis (MVT) is a rare but life threatening form of bowel ischemia. It is implicated in 6%-9% of all cases of acute mesenteric ischemia. The proportion of patients with primary (or idiopathic) MVT varies from 0% to 49%, with a decrease in frequency secondary to more recent availability of newer investigations for hypercoagulability. The presence of factor V Leiden (FVL) and prothrombin G20210A mutations (PGM) have been well documented in these cases. However, there have been scarce case reports describing MVT in heterozygotes of both these mutations occurring simultaneously and its implications on long term management. Our case describes acute MVT in a previously asymptomatic young patient with no prior history of venous thromboembolism. The patient was found to be heterozygous for FVL and PGM and treated with lifelong anticoagulation with warfarin (goal international normalized ratio: 2-3) and avoidance of hormonal contraceptives.
authors.affiliation: Paras Karmacharya, Madan Raj Aryal, Anthony Donato, Department of Internal Medicine, Reading Health System, West Reading, PA 19611, United States.
authors.forename: Paras
authors.initials: P
authors.lastname: Karmacharya
authors.forename: Madan Raj
authors.initials: MR
authors.lastname: Aryal
authors.forename: Anthony
authors.initials: A
authors.lastname: Donato
mesh_terms: D020016:Activated Protein C Resistance / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D000925:Anticoagulants / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects / Q000235:genetics*; D004252:DNA Mutational Analysis; D005165:Factor V / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease; D006579:Heterozygote; D006801:Humans; D019934:International Normalized Ratio; D007511:Ischemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D065666:Mesenteric Ischemia; D008641:Mesenteric Vascular Occlusion / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D008642:Mesenteric Veins; D009154:Mutation; D010641:Phenotype; D010690:Phlebography / Q000379:methods; D011516:Prothrombin / Q000235:genetics*; D014057:Tomography, X-Ray Computed; D014652:Vascular Diseases / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; C095381:factor V Leiden; D014859:Warfarin; D005165:Factor V; D011516:Prothrombin
keywords: Anticoagulation; Factor V Leiden; Heterozygous; Mesenteric vein thrombosis; Oral contraceptives; Prothrombin gene