# Factor V Leiden Heterozygous: Complicated by Recurrent Venous Thromboembolism and Bilateral Pulmonary Embolism

## TL;DR

A man with Factor V Leiden heterozygosity experienced multiple dangerous blood clots, challenging the usual understanding of the condition's risks.

## Contribution

Highlights an unusual case of recurrent VTE in a heterozygous FVL patient, suggesting a need for reevaluating anticoagulation strategies.

## Key findings

- A FVL heterozygous patient developed bilateral pulmonary embolism and recurrent DVT.
- Initial treatment with heparin failed to prevent recurrence, requiring repeat thrombectomy.
- The case suggests reconsideration of lifelong anticoagulation for FVL heterozygous individuals.

## Abstract

Factor V Leiden (FVL) is a hypercoagulable disorder that puts patients at increased risk of initial venous thromboembolism (VTE). However, those with heterozygote status are not usually susceptible to recurrent VTE. This is a case of a 35-year-old Caucasian male who presented to the emergency department with shortness of breath and chest pain. He had a past medical history of superficial thrombophlebitis and deep vein thrombosis (DVT) and was known to be FVL heterozygous. His home medications did not include anticoagulation medications at the time of presentation to the emergency department. The patient was diagnosed with bilateral pulmonary embolisms (PEs) secondary to a recurrent DVT. Initial treatment included a pulmonary thrombectomy and a lower extremity thrombectomy. Despite the patient being placed on heparin, there was a recurrence of the PE three days later, requiring a repeat pulmonary thrombectomy. This case of recurrent VTE in a heterozygous FVL patient is unusual and should lead to new considerations on the approach to lifelong anticoagulation in these patients.