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FVL Mutation and Surgery

This question was sent via the ASCLS Consumer Web Forum:

Are there increased risks for surgery for someone with one copy of factor V Leiden? If there are, does this rule someone out for major elective surgery (i.e. living donor organ transplant)?

This is the kind of question only the patient’s surgeon can answer, given the need for a full history and physical examination. however I’d like to get an expert opinion just for this entry.

My thought is that if the patient is currently on anticoagulant therapy, implying prior thrombotic events, she/he would need “bridging” therapy just before surgery using unfractionated or low molecular weight heparin. Surgeons stop the UFH drip about 4 hours before surgery and restart in the recovery room. If she/he is not on anticoagulant therapy, implying there has never been a thrombotic event, the surgeon is likely to prescribe anticoagulant therapy for after surgery to prevent a VTE, similar to treating a total hip or knee replacement.

Any thoughts?

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