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Factor V Leiden can complicate risk of clot after surgery

DEAR DR. ROACH: Over a year ago my husband had surgery. A couple of days later he was diagnosed with a blood clot in his calf. They did blood testing on him, and one test came back positive for “one copy of the Factor V Leiden Variant.” We have never heard of such a thing. He was put on 5 milligrams of Eliquis twice a day. We were told to have our children checked and so far, two have tested positive. They were told to make their doctors aware of it prior to surgery and during long periods of sitting to get some exercise.

We are wondering if my husband, who is in his 80s, still needs to take the Eliquis daily. Is this a condition that necessitates blood thinners for the rest of your life? If we were to travel, he could make sure he gets exercise and if he needs surgery he could let his doctors know. So far, they have not felt a reason to stop the blood thinner. — G.B.

ANSWER: Blood clots are common around the time of surgery, and there is much advice on how best to prevent them from happening in the first place. However, whether due to ineffective prevention or lack thereof, blood clots still occur.

The main risk of a blood clot is that it can break off and go to the lungs. This is called a pulmonary embolism. Medication can reduce that risk. For a person who had a blood clot around the time of surgery, the usual duration of treatment with apixaban (Eliquis) or similar medicine is three months.

Factor V Leiden is a common genetic variant of one of the blood clotting proteins. As is the case with most genes, there are two copies of factor V. Your husband has one normal copy and one variant copy. This does not alter the recommendations for duration of anticoagulation from a person with two normal genes. However, he might need medication to prevent a recurrent clot after future surgeries. A person with a history of blood clots in the leg is always at higher risk for another.

I don’t understand why he has been treated so long. You should ask his regular doctor or hematologist, because there may be some additional factors that have made them want to continue anticoagulation.

While your children are generally don’t need treatment, they should also be extra cautious during times of long travel. Tell them to frequently walk around, stretch their legs and stay hydrated.

DEAR DR. ROACH: I’m a hearing-impaired person who relies on lip-reading to communicate with others. With everyone wearing a mask now, I’m not able to talk to anyone. You can say that 2020 was a very lonely year for me. When are people going to quit wearing masks so I can talk to someone? Also, will I lose my voice if I don’t use it? Should I talk to a wall? — J.P.

ANSWER: The evidence at the time of this writing suggests that by the end of summer, the pandemic will likely be under enough control to begin to stop wearing masks and social distancing. However, many factors can influence this, and I will certainly take the guidance of experts. The emergence of new variants is a major unknown, none of us can predict the future with any certainty.

Your voice is not “use it or lose it.” There is no need to talk to the wall, but feel free to do so if it helps.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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