Two successful pregnancies in a carrier of heterozygous factor V LEIDEN mutation with aplasia of the inferior vena cava and a history of proximal deep venous thrombosis

Abstract

to our knowledge, only three cases of pregnancies in women with AIVC have been published [1–3]. In all these cases, AIVC was not known before pregnancy. In one patient, deep venous thrombosis (DVt) of the left leg was suspected at 22nd WOG and unfractionated heparin followed by enoxaparin 60 mg was applied. AIVC was diagnosed 3 weeks later, still no thrombosis was found [1]. pregnancy was terminated at 32nd WOG [1]. No information about co-existing thrombophilic risks was given. the second patient had three abortions and was tested negative for thrombophilic risk factors. to prevent additional abortion, she had bedrest throughout pregnancy being treated with enoxaparin 40 mg OD. pregnancy was terminated in the 38th WOG due to preeclampsia fetal intrauterine growth retardation. Despite anticoagulation, she suffered DVt 23-day postpartum and AIVC was diagnosed subsequently [2]. In the third patient, AIVC was diagnosed in the 7th WOG [3]. Laboratory evaluation showed homozygous methylenetetrahydrofolate reductase-C677t-mutation with normal fasting homocysteine levels. she was treated with 75 mg aspirin and 5 mg folic acid until 36th WOG. Due to deterioration of varicosities, aspirin was replaced by enoxaparin 40 mg OD until delivery [3]. In contrast to published cases, our patient has AIVC in combination with a relevant hereditary risk factor. In addition, she had suffered estrogen-related DVt. therefore, we were able to plan anticoagulation management during pregnancy beforehand and applied antepartum prophylaxis with intermediate-dose LMWH during pregnancy [4]. However, optimal LMWH dosage and anti-Xa target range for such patients is uncertain [4, 5]. Our case has significant implications for clinical practice. Most importantly, patients with AIVC, additional thrombophilic risks and former DVt can deliver healthy Dear editor,