Factor V Leiden & Pregnancy: What You Need to Know

Question
I am 28 years old and am 20 weeks pregnant with my first baby and everything up to this point has gone well.  I just found out that I have hetero Factor V leiden due to an inquiry I made at my last visit. My father almost died of a pulmonary embolism 5 years ago due to Factor V.  I discussed this with my doctor who immediately had me tested. I was on birth control pills for almost 7 years without any issues and have never had a blood clot.  I saw my Doctor this morning who said I needed to start on Lovenox immediately.  She then called a fetal specialist for me to see who told her not to put me on any medication until they do further tests.  So they drew more blood to test for additional blood clotting mutations or deficiencies. These tests will take a week or so to come back.  My Doctor seemed to disagree with the specialist in not treating me with the Lovenox.  She said he felt that if I just had this one mutation and no other positive results than I may not need any treatment since I was on the pill for so long with no clots.  I am concerned in the vast difference of opinions I saw this morning and was wondering if you had any insight.  If I am negative on all these additional tests, should I not take anything to prevent clotting?  Thanks!

Answer
Dear Samantha

Unfortunatelu I do not have extensive experience with the disorder you have since it is quite rare in our population.

However, as a general rule, pregnancy is known to be a hypercoagulable state and the possibility for any pregnant woman to have a blood clot is pronounced in those with any predisposing factor such as the one you have. Having no clot for 7 years while on the pill may give a false sense of security that you will never have 1. The hypercoagulability associated with pregnancy is much more than that associated with the pill.

Therefore, it would be my opinion to start on an anticoagulant under careful medical supervision so that you can get its benefit and avoid any possible side effects.

Good Luck