Factor V Leiden - NYSORA

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Factor V Leiden

Learning objectives

  • Description and management of Factor V Leiden

Definition and mechanisms

  • Factor V Leiden is an autosomal dominant inherited mutation of the F5 gene that controls the production of factor V, one of the clotting factors in the blood
  • Resulting in resistance to activated protein C thereby leading to thrombosis
  • It is the most common inherited blood clotting disorder 
  • Factor V Leiden increases the chance of developing a deep vein thrombosis or pulmonary embolism
  • However, most people with factor V Leiden never develop abnormal blood clots

Signs and symptoms

  • The factor V Leiden mutation does not itself cause any symptoms and the first indication is the development of a blood clot
  • Deep vein thrombosis
    • Pain
    • Swelling
    • Redness
    • Warmth
    • Tenderness
    • Abdominal pain
    • A severe, sudden headache and/or seizures
  • Pulmonary embolism
    • Sudden shortness of breath
    • Chest pain when breathing in
    • A cough that produces bloody or blood-streaked sputum
    • Wheezing
    • Tachycardia
    • Feeling light-headed or fainting

Risk factors

  • Immobility
  • Intake of estrogen-based therapies
  • Surgeries or injuries
  • Non-O blood type


  • Activated protein C blood test
  • Genetic testing


  • Anticoagulants are not routinely recommended for factor V Leiden
  • If DVT or PE is diagnosed, anticoagulantherapy is started as soon as possible
  • Consider that the patient:
    • May be on chronic anticoagulant therapy
    • Is at increased risk of perioperative  clotting events and need a DVT prophylaxis plan
  • See pulmonary embolism

Suggested reading

  • Shah UJ, Madan Narayanan M, J Graham Smith JH. 2015. Anaesthetic considerations in patients with inherited disorders of coagulation. Continuing Education in Anaesthesia Critical Care & Pain. 15;1 26-31.

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