Factor V Leiden Gene Mutation

In the absence of a personal thromboembolic history, Warfarin is not indicated - she may develop bleeding on it. However, given the strong family history, one should be concerned that additional thrombophilic problems are present and a full thrombophilia screen should be performed. If the rest of the screen is negative, one should still be cautious because of the family history - there may be thrombophilic tendencies we are yet to discover.

Pregnancy does not need heparin cover in this woman. The presence of Factor V Leiden itself does not prevent the use of the oral contraceptive or HRT, but given the strong family history, the woman should be counselled about the increased risk of thromboembolism versus the potential benefits and her decision documented for future reference.