# Massive Pulmonary Embolism Associated With Factor V Leiden Mutation in a Young Female on Oral Contraceptive Pills: A Case Report

## TL;DR

A young woman with a genetic clotting risk and birth control pills developed a severe blood clot in her lungs, highlighting the dangers of combining these factors.

## Contribution

Highlights the increased VTE risk in FVL carriers on OCPs and suggests targeted thrombophilia screening.

## Key findings

- A 34-year-old FVL heterozygous woman on OCPs developed massive bilateral pulmonary embolism.
- VTE risk increases 30-fold in heterozygous and 100-fold in homozygous FVL women on OCPs.
- Thrombophilia screening should be considered only with family history of VTE to prevent complications.

## Abstract

Factor V Leiden (FVL) is the major genetic risk factor to predispose venous thromboembolism (VTE). We present a rare case of a 34-year-old Caucasian female heterozygous for this mutation and taking oral contraceptive pills (OCPs) for less than four months, who presented to the emergency department with acute onset of dyspnea and was diagnosed to have an isolated massive bilateral pulmonary embolism (PE). The patient was managed for six days in the hospital and was discharged on oral anticoagulants. The risk for VTE in patients with factor V Leiden and on oral contraceptive pills increases by 30-fold in heterozygous women and 100-fold in homozygous women. The risk of VTE in factor V Leiden seems to outweigh the benefit of contraception with oral contraceptive pills. This case suggests that thrombophilia screening should be considered only in patients with a positive first-degree family history of VTE, where necessary, to prevent any future thrombotic morbidity and mortality.