ACTIVATED PROTEIN-C RESISTANCE (FACTOR-V-LEIDEN) ASSOCIATED WITH THROMBOSIS IN PREGNANCY

OBJECTIVE: Our purpose was to evaluate activated protein C resistance phenotype and genotype among patients with thrombosis during pregnancy and the puerperium. STUDY DESIGN: This observational study was conduc ted prospectively during a 2-year period (July 1993 to June 1995) in a preselected population. All patients admitted to our high-risk pregna ncy unit with a diagnosis of deep vein thrombosis, pulmonary emboli, t ransient ischemic attack, and cerebrovascular accident during pregnanc y and the puerperium were included. Prothrombin time, partial thrombop lastin time, fibrinogen revels, protein C, protein S, antithrombin III , functional test for activated protein C resistance, and factor V Lei den mutation by polymerase chain reaction were performed on each patie nt. RESULTS: Fifteen patients were included. Seven (46.6%) patients we re positive for activated protein C resistance (factor V Leiden). All other coagulation studies were negative for all patients. All patients with activated protein C resistance had a venous thrombotic event, de ep vein thrombosis, or pulmonary emboli, and only one had a cerebrovas cular accident on the basis of sagittal sinus thrombosis. Only two of the activated protein C resistance-negative patients had venous thromb osis (pulmonary emboli). The remaining six patients had transient isch emic attacks or cerebrovascular accidents. For the subgroup with venou s thrombosis during pregnancy and the puerperium, the incidence of act ivated protein C resistance (factor V Leiden) was 78%. CONCLUSION: Thi s study demonstrates the incidence of factor V Leiden in a selected po pulation in whom thrombotic events developed during pregnancy and the puerperium. This small-scale study provides justification for a large cohort study that will identify women with factor V Leiden and determi ne their risk for thrombosis during pregnancy and the puerperium. We b elieve that factor V Leiden should be evaluated in conjunction with th rombotic events in the pregnant woman.