Upper-extremity deep venous thrombosis in a woman on hormonal oral contraception with an inherited thrombophilia – Factor V Leiden

Abstract

Introduction: Upper extremity deep vein thrombosis (DVT) represents 10% of all cases of DVT. Genetic and acquired factors contribute to DVT. Factor V Leiden is the most common inherited thrombophilia. The use of oral contraceptives is also a recognized risk factor for DVT. The case of a female patient receiving a combined oral contraceptive who developed a upper-extremity deep venous thrombosis is presented. Case report: A 34 year-old Caucasian female presented to the emergency department with pain and swelling of the right arm. These symptoms began suddenly less than 24 hours earlier. She denied shortness of breath or thoracic pain. She had not experienced recent trauma. The patient had no chronic medical problems. She had been taking a combined oral contraceptive for two months. Her family medical history was negative for thromboembolic events. Doppler ultrasonography showed a venous thrombosis of terminal portion of right subclavian vein with 4 cm of extension. Anticoagulation therapy was started in the emergency department with enoxaparin 1mg/kg/day. This was followed by 6 months of oral anticoagulation therapy with acenocoumarol with a target INR of 2.0-3.0. The combined oral contraceptive was stopped. Thrombophilia screening was performed after completing anticoagulation. The patient was found to be heterozygous for factor V Leiden. Discussion: Factor V Leiden contributes to the risk of venous thromboembolism often in combination with an additional risk factor, such as oral contraceptive use. Patients should be counseled about reducing or eliminating other risk factors that may contribute to the development of venous thromboembolism.