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Bleeding and Clotting Disorders

Birth Contol Pill and Factor V

10/04/2010

Question:

Why do doctors not have to perform a blood test before placing someone on the pill? Why do they not even offer the choice to people about taking one? I never knew there was such a test till my 16 year old daughter died from a blood clot after she went on the pill. No one in my family ever had a blood clot problem and since my daughter’s death we have found out we all have factor V.

I do not understand why a simple blood test is not performed before placing someone on the birth control pill. If I knew there was such a thing I wouldn’t have cared if my insurance company covered it or not, I would’ve paid. But instead I paid with my daughter’s life.

Answer:

I am so very sorry about the death of your daughter. What you are bringing up is an important issue that has recently been receiving more attention.

Venous blood clots are caused by many factors, including inherited risk factors (FV Leiden) and acquired risk factors; oral contraceptive use is a common  risk factor. The risk for blood clots in a patient is a function of both the inherited and acquired risk factors, but there are other factors that play into it as well, some that we are aware of, and some that we are not.

Your daughter's case is an extremely rare event, but one that can happen. About 5% of Caucasians are carriers of the FVL mutation, and those who are found to be carriers are at greater risk for blood clots. Since other factors will intervene in patients, not all patients with FVL who use oral contraceptives will develop blood clots, let alone a fatal PE. They are just at a greater risk of doing so. Anyone with a family history of blood clots will typically be screened for these thrombophilia factors before putting them on oral contraceptives.

But people without FVL or other factors can still develop blood clots on oral contraceptives, especially if they smoke as well. It's a pretty complicated issue, with a lot of factors to consider. Although screening for FVL might help decrease the risk in some, it would not prevent all blood clots.

I hope I was able to help you out with what is really a complicated issue.

For more information:

Go to the Bleeding and Clotting Disorders health topic, where you can:

Response by:

Spero R Cataland, MD Spero R Cataland, MD
Associate Professor of Clinical Internal Medicine
College of Medicine
The Ohio State University