This handout is for factor v leiden thrombophilia dvt (heterozygous or homozygous). Your care team identified this based on: unilateral leg swelling or proven dvt in patient with strong family history of vte (first-degree relative under 50) — pretest probability for heritable thrombophilia including fvl is elevated.
Other reasons your team may use this plan: first vte under age 45 with no provoking factor — ash 2018 indication to consider heritable thrombophilia testing including fvl pcr; recurrent vte with minor or no provoking factors — strong indication for thrombophilia evaluation and likely indefinite ac; cerebral venous, splanchnic, or upper-extremity thrombosis without obvious cause → broader thrombophilia panel including fvl.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| apixaban | 10 mg BID × 7 d → 5 mg BID full-dose; 2.5 mg BID extended-phase after first 6 mo if continuing indefinite | PO | BID × ≥3 months minimum, indefinite if homozygous/unprovoked/concurrent thrombophilia | AMPLIFY (Agnelli NEJM 2013 PMID 23808982) — apixaban first-line; AMPLIFY-EXT (Agnelli NEJM 2013 PMID 23216615) — 2.5 mg BID extended-phase preserves efficacy with lower bleed; FVL subgroup analyses show DOAC efficacy preserved |
| rivaroxaban | 15 mg BID × 21 d → 20 mg daily; 10 mg daily extended-phase after first 6 mo if continuing indefinite | PO | BID then daily ≥3 months, indefinite per criteria | EINSTEIN-DVT (Bauersachs NEJM 2010 PMID 21128814); EINSTEIN-CHOICE (Weitz NEJM 2017 PMID 28316279) — 10 mg daily extended-phase non-inferior to 20 mg with less bleed |
| edoxaban | 60 mg PO daily (30 mg if CrCl 15-50, weight ≤60 kg, or with strong P-gp inhibitor) after 5-10 d LMWH bridge | PO | daily × ≥3 months, indefinite per criteria | Hokusai-VTE (Büller NEJM 2013 PMID 23991958) — non-inferior to warfarin after LMWH lead-in |
| warfarin | 5 mg daily; INR target 2-3 (target 3 if triple-positive APS per ISTH) | PO | daily ≥3 months, indefinite per criteria | TRAPS (Pengo Blood 2018 PMID 30002145) — warfarin > rivaroxaban in triple-positive APS; ISTH 2020 — DOACs avoided in triple-positive APS |
| enoxaparin | 1 mg/kg SC BID; reduce to 1 mg/kg daily if CrCl <30 | SC | BID | ASH 2020 (PMID 33007077); ASH 2018 pregnancy (PMID 30482767) — LMWH first-line in pregnancy and as bridge during workup; safer if concurrent APS suspected pre-confirmation |
| heparin | 80 U/kg bolus + 18 U/kg/h targeting aPTT 1.5-2.5× | IV | continuous | Reversibility for acute peri-procedural management (ACCP 2021) |
| aspirin | 81 mg daily as adjunct or as fallback if AC discontinued in low-risk extended phase | PO | daily | WARFASA (Becattini NEJM 2012 PMID 22621626) + ASPIRE (Brighton NEJM 2012 PMID 23121403) — ASA modest VTE recurrence reduction (~30%) post-AC; inferior to extended-phase DOAC but option if patient refuses AC |
Plan: Factor V Leiden thrombophilia — acute + extended-phase AC tailored to zygosity, provoking factor, and concurrent thrombophilia (ACCP 2021; ASH 2020; TRAPS 2018)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Genetic counseling for proband; first-degree relative screening discussion (ACMG / ASH 2018 — test only if result will change management, e.g. pre-OCP, pre-pregnancy, pre-high-risk-surgery); pregnancy planning for women (LMWH if homozygous or prior VTE); OCP discontinuation; address modifiable risk factors lifetime
Guideline: ACCP/CHEST 2021 (Stevens) + ASH 2018 thrombophilia testing + ASH 2020 VTE Treatment + ASH 2018 VTE in Pregnancy