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Women and their Blood

© Laura Ruth

Abnormal blood clotting affects people other than the males in a royal family. The Factor V Leiden mutation is a common inherited thrombophilic state. The "hypercoagulable" blood is caused by a defect in a protein in the blood. DNA testing can screen for the Factor V Leiden Mutation. The Factor V Leiden Mutation occurs in 3-8% of European populations. It is found in approximately 15-20% of patients with a first deep venous thrombosis and up to 50% of patients with a recurrent venous thromboembolism (VTE) or women with estrogen-related thromboses.

Oral contraceptives increase the risk of venous thromboembolism by eight fold in women who are heterozygous for the Factor V Leiden mutation. Therefore, women who have an inherited "hypercoagulable" state, such as the Factor V Leiden mutation, should not be given oral contraceptives.

The "hypercoagulable" state also affects pregnancy. The rate of fetal loss (especially stillbirth) is increased. The risk of postpartum VTE also increases in patients with inherited protein deficiencies, such as the Factor V Leiden mutation. People with a history of VTE should receive full-dose anticoagulation therapy with heparin for the entire pregnancy, but treatment for people who are carriers of an inherited state, such as the Factor V Leiden mutation, is not clear-cut.

A risk of a "hypercoagulable" state requires the pros-n-cons of hormone replacement to be reviewed. Hormone replacement therapy will improve cardiovascular mortality. However, recent studies show a twofold to fourfold relative risk of venous thromboembolism among perimenopausal and postmenopausal women who receive hormone replacement therapy.

Literature References

Kujovich, J.L. and Goodnight, S.H., "Factor V Leiden and the Prothrombin Gene Mutation: Two Common Genetic Defects Associated with Thrombosis," Western Jouranl of Medicine, 168(6): 524-525, 1998.

Rao, A.K., et al, "Inherited Thrombophilic States," Seminars in Thrombosis and Hemostasis, 24, Suppl. 1, 3-12, 1998.

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