Factor strongVstrong Leiden and Perioperative Risk - Dr Luis Gallur.pdfVIP

REVIEW ARTICLE Factor V Leiden and Perioperative Risk Brian S. Donahue, MD, PhD Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee Factor V Leiden (FVL) is the most common known inher- and unproven hypotheses regarding FVL in this popula- ited cause of thrombophilia; it is present in approximately tion, and these therefore highlight the need to comprehen- 5% of the Caucasian population. Although the risk of ve- sively address this issue. This review will describe the nous thrombosis associated with this polymorphism in physiology of the FVL mutation, briefly clarify its risk in various medical settings is well described, its effect on the nonsurgical setting, and assess current data regarding perioperativeriskisonlybeginningtobeexplored.Specif- FVL in noncardiac and cardiac surgery. Finally, a sum- ically, there are few studies addressing the potential risks mary of current clinical evidence and a plan for more de- of FVL in the surgical population, in which both hemor- tailed investigation of this potentially significant risk fac- rhagic and thrombotic complications convey substantial tor will be proposed. clinical and economic significance. There are speculations (Anesth Analg 2004;98:1623–34) ypercoagulable states describe a heterogeneous Today, because genetic testing for inherited throm- Hmix of clinical and inherited risk factors for bophilias is becoming more commonplace, anesthesi- thrombotic events and are significant contribu- ologists are likely to see more genetic data listed on tors to adverse patient outcomes. Venous thrombosis preoperative laboratory reports. This often leaves is an important cause of morbidity in