Mesenteric vein thrombosis in a patient heterozygous for factor V Leiden and G20210A prothrombin genotypes

World J Gastroenterol. 2013 Nov 21;19(43):7813-5. doi: 10.3748/wjg.v19.i43.7813.

Abstract

Mesenteric venous thrombosis (MVT) is a rare but life threatening form of bowel ischemia. It is implicated in 6%-9% of all cases of acute mesenteric ischemia. The proportion of patients with primary (or idiopathic) MVT varies from 0% to 49%, with a decrease in frequency secondary to more recent availability of newer investigations for hypercoagulability. The presence of factor V Leiden (FVL) and prothrombin G20210A mutations (PGM) have been well documented in these cases. However, there have been scarce case reports describing MVT in heterozygotes of both these mutations occurring simultaneously and its implications on long term management. Our case describes acute MVT in a previously asymptomatic young patient with no prior history of venous thromboembolism. The patient was found to be heterozygous for FVL and PGM and treated with lifelong anticoagulation with warfarin (goal international normalized ratio: 2-3) and avoidance of hormonal contraceptives.

Keywords: Anticoagulation; Factor V Leiden; Heterozygous; Mesenteric vein thrombosis; Oral contraceptives; Prothrombin gene.

Publication types

  • Case Reports

MeSH terms

  • Activated Protein C Resistance / blood
  • Activated Protein C Resistance / complications
  • Activated Protein C Resistance / diagnosis
  • Activated Protein C Resistance / drug therapy
  • Activated Protein C Resistance / genetics*
  • Anticoagulants / therapeutic use
  • Blood Coagulation / drug effects
  • Blood Coagulation / genetics*
  • DNA Mutational Analysis
  • Factor V / genetics*
  • Female
  • Genetic Predisposition to Disease
  • Heterozygote
  • Humans
  • International Normalized Ratio
  • Ischemia / blood
  • Ischemia / diagnosis
  • Ischemia / drug therapy
  • Ischemia / genetics*
  • Mesenteric Ischemia
  • Mesenteric Vascular Occlusion / blood
  • Mesenteric Vascular Occlusion / diagnosis
  • Mesenteric Vascular Occlusion / drug therapy
  • Mesenteric Vascular Occlusion / genetics*
  • Mesenteric Veins*
  • Mutation*
  • Phenotype
  • Phlebography / methods
  • Prothrombin / genetics*
  • Tomography, X-Ray Computed
  • Vascular Diseases / blood
  • Vascular Diseases / diagnosis
  • Vascular Diseases / drug therapy
  • Vascular Diseases / genetics*
  • Venous Thrombosis / blood
  • Venous Thrombosis / diagnosis
  • Venous Thrombosis / drug therapy
  • Venous Thrombosis / genetics*
  • Warfarin / therapeutic use
  • Young Adult

Substances

  • Anticoagulants
  • factor V Leiden
  • Warfarin
  • Factor V
  • Prothrombin

Supplementary concepts

  • Thrombophilia due to Activated Protein C Resistance