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is it safe to have more children
I am 23 years old and just found out that I am Positive for one copy of the R506Q ( Factor V Leiden) mutation. I got a DVT in my left leg at 9 weeks gestation during my second pregnancy and have never had any major prior health problems (well i've had endometriosis but i think that is irrelevant, but if not please advise) or known family history of thrombosis. I didn't have any problems with my first pregnancy in 2004 and have had surgery twice for the endometriosis (2005- 2006) which resulted in the removal of my right fallopian tube at the second surgery, also I was on various birth control pills since I was 14 due to very bad periods. I've been reading up on everything and the risks Coumadin has on internal hemmoraging and am a little scared of the effects.My doctor has told me that I will have to take the pills for the rest of my life. Also the risks associated with pregnancy and FVL are frightening.I plan on getting the peragon IUD for the time being as that is my only option for a birth control but am unsure if that will continue with the suppression of the endometriosis since it has no hormone.
Questions
1. Why didn't I get a clot with my first pregnancy or after the surgeries since it seems to have been brought on my hormone changes? And since I got it during pregnancy what are the chances of getting another if I were to get pregnant again?
2. Should I even consider going through another pregnancy and what is the reality of my health issues and the health and risks of the unborn child that could arise ?
3. Should I continue the 5mg a day on Coumadin since this is my 1st occurance and taking into consideration my family history of no clots (also in getting a doppler reading a week ago the clot is still there but is diminishing slowly)? or should i continue until clot is completely gone? Could taking a baby aspirin a day and adding herbs with anticoagulant activity do the job? would it be safe to be on if i were to plan on having another child?
Questions
1. Why didn't I get a clot with my first pregnancy or after the surgeries since it seems to have been brought on my hormone changes? And since I got it during pregnancy what are the chances of getting another if I were to get pregnant again?
2. Should I even consider going through another pregnancy and what is the reality of my health issues and the health and risks of the unborn child that could arise ?
3. Should I continue the 5mg a day on Coumadin since this is my 1st occurance and taking into consideration my family history of no clots (also in getting a doppler reading a week ago the clot is still there but is diminishing slowly)? or should i continue until clot is completely gone? Could taking a baby aspirin a day and adding herbs with anticoagulant activity do the job? would it be safe to be on if i were to plan on having another child?
A related discussion, Factor V and Protein S deficiency was started.
MEDICAL PROFESSIONAL
Questions
1. Why didn't I get a clot with my first pregnancy or after the surgeries since it seems to have been brought on my hormone changes? And since I got it during pregnancy what are the chances of getting another if I were to get pregnant again?
Having 1 copy does not mean you will definitely have a clot--it just means you have an increased risk compared to the normal population.
This is from a great article in Circulation: http://circ.ahajournals.org/cgi/content/full/107/15/e94#TBL1
"Heterozygous factor V Leiden is found in about 5% of the white population and is most common in people of Northern European descent and in some Middle Eastern populations, whereas the homozygous form is found in fewer than 1%. Factor V Leiden is less common in the Hispanic populations and is rare in Asian, African, and Native American populations.
Factor V Leiden is associated with an increased risk of developing an episode of DVT (with or without a PE). Approximately 1 in every 1000 people will develop a DVT or PE each year, and this increases from about 1 in 10 000 for those in their twenties to about 5 in 1000 for those in their seventies. Heterozygous factor V Leiden increases the risk of developing a first DVT by 5- to 7-fold (or 5 to 7 in 1000 people each year). Thus, even though the relative risk of developing a DVT seems high, the absolute risk of having a DVT is still quite low with factor V Leiden. Factor V Leiden is thus a weak risk factor for developing blood clots; in fact, most people who have heterozygous factor V Leiden never develop blood clots. Homozygous factor V Leiden increases the risk of developing clots to a greater degree, about 25- to 50-fold. If you have the heterozygous form of factor V Leiden, the lifetime risk of developing a DVT is 10% or less, but may be higher if you have close family members who have had a DVT. Very often, people with factor V Leiden have additional risk factors that contributed to the development of blood clots (Table). Having factor V Leiden alone does not appear to increase the risk of developing arterial thrombosis, that is, heart attacks and strokes. "
2. Should I even consider going through another pregnancy and what is the reality of my health issues and the health and risks of the unborn child that could arise ?
That is up to you. Since you had a clot this would increase the risk of you having another especially if you become pregnant. I would imagine that you would have to be switched to injectable blood thinners like Heparin of Lovenox when you are pregnant.
This is again from the circulation article:
"It is not usually recommended that people with factor V Leiden be treated lifelong with anticoagulants if they have had only one DVT or PE, unless there are additional risk factors present (Table). Having had a DVT or PE in the past increases your risk for developing another one in the future, but having factor V Leiden does not seem to add to the risk of having a second clot. If you have factor V Leiden but have never had a blood clot, then you will not routinely be treated with an anticoagulant. Rather, you should be counseled about reducing or eliminating other factors that may add to your risk of developing a clot in the future. In addition, you may require temporary treatment with an anticoagulant during periods of particularly high risk, such as major surgery.
3. Should I continue the 5mg a day on Coumadin since this is my 1st occurance and taking into consideration my family history of no clots (also in getting a doppler reading a week ago the clot is still there but is diminishing slowly)? or should i continue until clot is completely gone? Could taking a baby aspirin a day and adding herbs with anticoagulant activity do the job? would it be safe to be on if i were to plan on having another child?
You should continue the anticoagulation until the clot is resolved and when your doctor says it is ok to stop.
You will need to be on injectable forms for anticoagulation and switch from Coumadin when you are wanting to get pregnant.
You should definitely not take any herbs!
As per the article above, you will not have to take anticoagulation forever, if you only had 1 clot but if you are pregnant or having any high risks then you would.
These are the high risk factors:
Risk Factors for Developing a DVT or PE
Obesity
Cancer
Immobility
Hospitalization
Surgery or trauma
Pregnancy
Taking oral contraceptives
Taking hormone replacement therapy (including estrogens, raloxifene, tamoxifen)
Some chronic medical conditions (such as diabetes and congestive heart failure)
Air travel (greater than 3000 kilometers or about 4 hours)
Hereditary thrombophilia (such as deficiencies of protein C, protein S, or antithrombin; factor V Leiden, prothrombin gene mutation)
Some acquired blood conditions (such as antiphospholipid antibodies or elevated levels of homocysteine)
You should have a serious consultation with a high risk doctor re: trying to get pregnant again and you would have to decide after the discusssion.
1. Why didn't I get a clot with my first pregnancy or after the surgeries since it seems to have been brought on my hormone changes? And since I got it during pregnancy what are the chances of getting another if I were to get pregnant again?
Having 1 copy does not mean you will definitely have a clot--it just means you have an increased risk compared to the normal population.
This is from a great article in Circulation: http://circ.ahajournals.org/cgi/content/full/107/15/e94#TBL1
"Heterozygous factor V Leiden is found in about 5% of the white population and is most common in people of Northern European descent and in some Middle Eastern populations, whereas the homozygous form is found in fewer than 1%. Factor V Leiden is less common in the Hispanic populations and is rare in Asian, African, and Native American populations.
Factor V Leiden is associated with an increased risk of developing an episode of DVT (with or without a PE). Approximately 1 in every 1000 people will develop a DVT or PE each year, and this increases from about 1 in 10 000 for those in their twenties to about 5 in 1000 for those in their seventies. Heterozygous factor V Leiden increases the risk of developing a first DVT by 5- to 7-fold (or 5 to 7 in 1000 people each year). Thus, even though the relative risk of developing a DVT seems high, the absolute risk of having a DVT is still quite low with factor V Leiden. Factor V Leiden is thus a weak risk factor for developing blood clots; in fact, most people who have heterozygous factor V Leiden never develop blood clots. Homozygous factor V Leiden increases the risk of developing clots to a greater degree, about 25- to 50-fold. If you have the heterozygous form of factor V Leiden, the lifetime risk of developing a DVT is 10% or less, but may be higher if you have close family members who have had a DVT. Very often, people with factor V Leiden have additional risk factors that contributed to the development of blood clots (Table). Having factor V Leiden alone does not appear to increase the risk of developing arterial thrombosis, that is, heart attacks and strokes. "
2. Should I even consider going through another pregnancy and what is the reality of my health issues and the health and risks of the unborn child that could arise ?
That is up to you. Since you had a clot this would increase the risk of you having another especially if you become pregnant. I would imagine that you would have to be switched to injectable blood thinners like Heparin of Lovenox when you are pregnant.
This is again from the circulation article:
"It is not usually recommended that people with factor V Leiden be treated lifelong with anticoagulants if they have had only one DVT or PE, unless there are additional risk factors present (Table). Having had a DVT or PE in the past increases your risk for developing another one in the future, but having factor V Leiden does not seem to add to the risk of having a second clot. If you have factor V Leiden but have never had a blood clot, then you will not routinely be treated with an anticoagulant. Rather, you should be counseled about reducing or eliminating other factors that may add to your risk of developing a clot in the future. In addition, you may require temporary treatment with an anticoagulant during periods of particularly high risk, such as major surgery.
3. Should I continue the 5mg a day on Coumadin since this is my 1st occurance and taking into consideration my family history of no clots (also in getting a doppler reading a week ago the clot is still there but is diminishing slowly)? or should i continue until clot is completely gone? Could taking a baby aspirin a day and adding herbs with anticoagulant activity do the job? would it be safe to be on if i were to plan on having another child?
You should continue the anticoagulation until the clot is resolved and when your doctor says it is ok to stop.
You will need to be on injectable forms for anticoagulation and switch from Coumadin when you are wanting to get pregnant.
You should definitely not take any herbs!
As per the article above, you will not have to take anticoagulation forever, if you only had 1 clot but if you are pregnant or having any high risks then you would.
These are the high risk factors:
Risk Factors for Developing a DVT or PE
Obesity
Cancer
Immobility
Hospitalization
Surgery or trauma
Pregnancy
Taking oral contraceptives
Taking hormone replacement therapy (including estrogens, raloxifene, tamoxifen)
Some chronic medical conditions (such as diabetes and congestive heart failure)
Air travel (greater than 3000 kilometers or about 4 hours)
Hereditary thrombophilia (such as deficiencies of protein C, protein S, or antithrombin; factor V Leiden, prothrombin gene mutation)
Some acquired blood conditions (such as antiphospholipid antibodies or elevated levels of homocysteine)
You should have a serious consultation with a high risk doctor re: trying to get pregnant again and you would have to decide after the discusssion.
I am 23 years old and have had 2 successful pregnancies all the while knowing I had Factor 5 Leiden. I of course was considered high risk with both, but there are precautions to take. With both of my pregnancies, I had to give myself shots 2 times a day of Lovenox (a blood thinner, stronger than heparin) and my blood thickness was closely monitored (blood draw a few times a week until the dosage was right). I did that until the day I had my baby and then I was on coumadin for 6 weeks after having both (then I was weened off of all blood thinners). My sister also has the same disorder and had an IV pump (depending on the resources in your area and your insurance) and typically has done the same things as me for pregnancies only she has had blood clots 2 times while pregnant (1 with her first and one with second. After her second has passed away at 2 days old they did tests on her and the baby to find out why and found out she had the factor V, he didn't and that's why she took the blood thinner with the next 2 successful pregnancies) and I haven't. Neither of us are on coumadin and neither take a baby aspirin (unless taking a trip or sitting for long period of time). It really depends on what doctor you see, but if I were you I'd get a second opinion on having to take coumadin for the rest of your life and maybe even a 3rd. The Lovenox and heparin do not cross into the placenta to the baby but coumadin does. I really hope you find this helpful. I've had a long 2 pregnancies, therefore chose not to have more children, but having the Factor 5, you can still definately have perfectly happy healthy children.
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