Early occlusion of coronary by-pass associated with the presence of factorV Leiden and the prothrombin 20210A allele: case report

The presence of factor V Leiden mutation and the variation of the prothromb in gene 20210GA have been described as additional risk factors for arterial thrombosis when other acquired or metabolic risk factors are present. We r eport here a 56-year-old man who developed coronary artery disease since 19 80 without any known risk factor and underwent a cardiopulmonary by-pass in 1997. In the first month after surgery, he became symptomatic, and an angi ography showed complete occlusion of the grafts and some native coronary ar teries. Three months after the second cardiopulmonary by-pass, a thrombophi lic state was searched, and plasma levels of lipoprotein (a) (LPa) were mea sured. The patient is heterozygous for factor V Leiden mutation and has the variation 20210GA of the prothrombin gene and high levels of LPa. These fi ndings induced us to add oral anticoagulation to the aspirin treatment, and the patient is ina good condition 11 months later. (C) 1999 Lippincott Wil liams & Wilkins.