| Patient population | Intervention(s) that may be appropriate |
| VTE risk reduction for asymptomatic individuals |
| All individuals | - Surgery – Treat as a high-risk group for purposes of surgical VTE prophylaxis. No differences in the choice or dosing of prophylactic anticoagulant.
- Routine anticoagulation – Generally not indicated. The rare homozygote or double heterozygote may choose prophylactic anticoagulation if they place an especially high value on VTE risk reduction and are willing to accept the increased risk of bleeding.
- Airline travel – Frequent ambulation; below-the-knee graduated compression stockings for selected individuals.
|
| Additional considerations for women | - Estrogen-containing contraceptives – Avoid in homozygotes and double heterozygotes. Avoid in heterozygotes if an acceptable alternative is available. If used, select a pill with a low estrogen dose.
- Pregnancy – Routine antepartum or postpartum anticoagulation is not required for heterozygotes. Intermediate-dose anticoagulation antepartum and postpartum for the rare homozygote or double heterozygote. Low-dose postpartum anticoagulation after cesarean delivery for two weeks in heterozygotes.
|
| VTE treatment |
| | - Heterozygotes – No difference from the general population.
- Homozygotes or double heterozygotes – Indefinite anticoagulation unless contraindicated.
|
| Pregnancy morbidity |
| | - No difference from the general population. Some women may reasonably choose aspirin or anticoagulation if no other explanation can be found.
|
| Family members |
| First- and second-degree relatives | - Testing is not always necessary. The decision is individualized based on whether the information would have clinical utility.
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