factor v leiden mutation-heterozygous and treatment

dear doctor, one of my  patient had a still born baby boy at 30 weeks gestational age followed by 2 early miscarriages, pathological report demonstrated clot in placenta and fetal growth retardation, having further thrombophilia profile resulted with factor v leiden mutation heterozygous, she is pregnant now on 5mg folic acid daily, and under treatment of fetal medicine consultant , but not given any of the anti- coagulant prophylactic therapy, I mentioned to consultant about having this but she denied of prescribing any. What is your expert opinion?

[John Kim, M.D.]

I agree with you. With her history of factor V leiden-heterozygous and 30 week still-born with pathology proven clot and then 2 early miscarriages, I think the patient should be offered low dose anti-coagulant prophylactic therapy. I suggest obtaining another MFM consultation for prescribing this.