Anticoagulation management in patients diagnosed with Factor V Leiden should be guided primarily by the clinical context of venous thromboembolism (VTE), such as deep vein thrombosis (DVT) or pulmonary embolism (PE), rather than the presence of Factor V Leiden alone.
Factor V Leiden is a hereditary thrombophilia, and current UK guidelines recommend that thrombophilia testing, including for Factor V Leiden, is considered mainly in people with unprovoked VTE who have a first-degree relative with VTE, and if anticoagulation treatment is planned to be stopped. Testing is not routinely recommended for those continuing anticoagulation or for provoked VTE cases NICE CKS,NICE NG158.
For patients with confirmed VTE and Factor V Leiden, anticoagulation treatment follows the standard protocols for VTE management, which include initial treatment with direct oral anticoagulants (DOACs) such as apixaban or rivaroxaban, or low molecular weight heparin (LMWH) followed by vitamin K antagonists (VKAs) if DOACs are unsuitable NICE NG158.
Duration of anticoagulation depends on whether the VTE was provoked or unprovoked, bleeding risk, and patient preferences. Long-term anticoagulation may be considered in unprovoked VTE or recurrent events, with regular annual review of risks and benefits NICE NG158.
Routine thrombophilia status, including Factor V Leiden, does not usually alter the choice or duration of anticoagulation treatment but may influence decisions about stopping anticoagulation in some cases NICE CKS,NICE NG158.
Patients should be provided with verbal and written information about anticoagulation, including side effects, monitoring, and precautions during pregnancy or other risk situations NICE NG158.