Factor V Leiden and Prothrombin Gene Mutation Questions

[BabsD]

I'm a 37 yr old woman who was diagnosed at 31 as having had a silent heart attack, although the doctors don't know when it
happened. I was having PVCs(benign), which I mentioned to my Internist during a routine exam. An ekg showed abnormal results, and an echo showed a small area of damage. I next had a thallium stress test, and a heart catheterization showed damage from a moderate heart attack, although I had normal coronary arteries. I had taken the Pill for 5 yrs prior to diagnosis, and my cardiologist is assuming that the MI was caused by a blood clot, possibly related to the pill, although I guess I will never know for sure what caused it.

I've had several echos and stress tests since diagnosis, with no change.I have never smoked or taken drugs, drink rarely and am otherwise healthy,although I am 35 lbs overweight. My EF is 50, blood pressure normal, all other tests have come back negative/normal:clotting/coagulation tests,diabetes,lupus, Lyme,excess iron,hepatitis,HIV, lipoprotein a, anti-phosholipid antibody, anti-nuclear antibody tests,etc. I currently take 1 mg folic acid, 81 mg aspirin, 25 mg atenolol, fish oil and a multivitamin. My total cholesterol:186, HDL:43 LDL:130 Trig:68.

I want to become pregnant soon, so I spoke to a Maternal/Fetal specialist. She reviewed my records,and recommended testing for Factor V Leiden and Prothrombin Gene Mutation-I am still waiting for the results. What are the implications for me if either or both come back positive? What treatments are available?  What would my prognosis be? Should I avoid becoming pregnant?

[CCF-M.D.-CRC]

Dear babs,

These questions are really more in the expertise of a hematologist but I can tell you what I am aware of in this area.  Factor V Leiden and prothrombin gene mutation are both involved in the clotting cascade and abnormalities in either of these can lead to venous blood clots.  This still would not explain your heart attack unless you also have a patent foramen ovale (PFO) which would allow the clot to travel from the venous side to the arterial side and cause a heart attack.  

If you did have one of these clotting abnormalities a decision would have to be made in regard to chronic anticoagulation.  If the heart changes were the only finding and there were no other blood clotting events I would probably recommend not anticoagulating but this would  be a clinical judgement best made by a hematologist.  If the decision was made to anticoagulate then special measures would need to be taken should you desire to become pregnant.

The best solution would be if the blood tests come back negative and no anticoagulation is needed.  This still does not answer the heart attack question.  It may be that you had an episode of viral myocarditis that left some focal scarring in your heart.  We have seen this here at the Cleveland Clinic.

[kd re: longstanding MR]

Ask for an anticardiolipin profile (IgG, IgM, and IgA) also.  I have antiphospholipid antibody syndrome (APS), and autoimmune system clotting disorder that only shows up in the IgM.  I passed the tests you mentioned and a whole slew of others.  Lupus is frequently found with APS and can affect your being able to carry a baby to term without intervention.  In my case, because no one thought to test the IgM, I am left with numerous TIAs, several strokes, liver lesions, clots in my arm and leg that has affected my ability to use my foot, and seizure activity.  So, I am advocating APS testing whenever someone asks questions such as yours.  It could be a factor.
kd

[BabsD]

As I stated in my question, I was tested for anti-phospholipid antibodies. I don't remember it being called an anticardiolipin profile, but I'm assuming its the same thing.  I was also tested for lupus.

[testnerd]

patient has just had pyloric bleeding ulcer. One week later, DVT of right leg.
Being tested for several clotting factors.
Any known correlation between clotting factors, ulcer AND DVT?
thanks for any info

[alvaro]

I´m 62 yr old,have had 3 isquemic cerebral accidents,of which the first one at 44 years old.

I´ve been tested for prothrombin mutation ,and the result was heterozygote.

How must I conduct my prevention treatment and  what should I do as regards familial testing?

[JoJo_55]

A related discussion, dvt with 3 mutations was started.