Wednesday, December 21, 2005
G20210A
Quick question. I have seen this 60 y/o woman in the hospital with B/L pulmonary emboli and DVTs. She has COPD (moderate), OSA and obesity. She was D/C'ed on coumadin and actually received a little over 6 months b/c she underwent a total knee replacement 6 months after the PE. She is now off coumadin, her levels of proteins C&S and ATIII are normal but she is heterozygous for the prothrombin gene mutation at AA 20210. This is a first episode of VTE but she had a lot of clot in her CT with a single genetic defect (no factor V Leiden). Would you recommend indefinite anticoagulation?
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To my understanding, heterozygotes are at a significant risk of developing VTE disease.
I would anticoagulate her for life.
Check out this reference:
Simioni P et al. Blood 2000 Nov 15;96(10):3329-33.
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