Factor V Leiden clotting disorder

Question

Is it common for doctor's to order genetic blood clotting disorder tests prior to surgery as part of a medical clearance. Is a PT/INR and PTT not adequate?

Ronald J. Edelson, MD · Answer

Some surgeon check these and others don’t.  I don’t check clotting factors because of low yield. But we do ask patients if they have a history of abnormal  Bleeding  or clots

Gianfranco Frojo, MD · Answer

If there are any positive responses to bleeding/clotting disorders in the medical history....absolutely. Factor V Leiden is present in about 5% of Caucasians and 1% of non-Caucasians. The risk of having a blood clot is 1:100,000 if the patient has one of the gene mutation and can be higher up to 1:10,000 if there are two mutations.

Robert M. Wald, Jr., MD · Answer

It is not common to order extra clotting studies, other than a PT,PTT, and platelets prior to surgery. If there is any history of bleeding or family history of blood disorders, this would be indicated. Sometimes, doctors are extremely careful and will order these tests anyway.

Pasha Mostofi, MD, DMD · Answer

Factor V Leiden (FVL) is a genetic mutation that makes it more likely for an individual to form blood clots, however, what makes this a little more complicated is that fact that people can have varying degrees of risk...and this depends on whether you have one or two copies of the mutated FVL gene. Those folks that have two copies of the mutated gene have a higher risk, while those only with one copy of the mutated gene have a lower risk of developing blood clots. Another factor to consider is the type of surgical procedure you are having. For example, a facelift surgery generally has much less blood loss, compared to...lets say...an orthopedic surgical case, which could also mean less risk with developing blood clots. HOWEVER, with all this said, the best thing to do is to consult with your hematologist so they can inform and guide you with what should be considered prior to any surgery.

Zoran Potparic, MD · Answer

Whenever there is a reason to suspect blood clothing as a cause of deep vain or pulmonary embolism proper studies should be performed. You should trust your surgeon because that is about your safety. Good luck.

Audrey Nguyen, MD · Answer

This is not unheard of, and I think your surgeon is being thorough to assess your risk of a bleeding or clotting complication (such as a pulmonary embolism or DVT) after surgery. PT/INR/PTT does not give complete information about bleeding or clotting disorders. 
I order bleeding/clotting panels if my patients screen positive for a history of heavy menstrual bleeding, blood clots or clotting in the family history. For example, I order a von willebrand factor panel if my patients report a history of heavy menstrual bleeding as this is one of the most common symptoms of von willebrand's disease. 
Factor V Leiden is more common than you would think and increases one's risk of a blood clot after surgery. There is something called the Caprini Score that plastic surgeons use to evaluate clotting risk.

William Aiello, MD · Answer

Hi!

If there is concerns for any genetic disorder that could interfere with surgery and potentially cause complications during and after surgery, then a genetic testing is certainly appropriate.

Sometimes, when you have a genetic clotting disorder, you might have other genetic disorders that could be helpful for the surgeon to know and address before surgery so you decrease your risks of complications.

A PT/INR and PTT are lab orders to understand your coagulation system in your body and doesnt say anything about your genetics.

Call us anytime for any questions!

William Portuese, MD · Answer

It's very important that you get medical clearance from your primary care physician or your hematologist before undergoing elective cosmetic surgery with factor five Leiden. You're more at risk for a blood clot in your legs after a general anesthetic, and you usually cannot go on blood thinners after surgery

Factor V Leiden clotting disorder

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