Blood Clotting Factor Defects in Relation to COVID-19: Factor V Leiden

Written by: Sarah Weathers and Tawni Wilkinson

Since the emergence of COVID-19, unusual blood clotting presentations have become a
prevalent issue and can be concerning for both men and women. Early in the pandemic it was
recorded that there was an elevated level of factor V activity in patients with severe COVID-19.
Factor V is an important type of glycoprotein that contributes to both enabling and inhibiting
blood clotting in various situations. Factor V Leiden (FVL) is a mutation that affects the factor V
gene preventing the blood from clotting properly. With this mutation, some individuals will
experience the mutation while others will not. As a result of the mutation, factor V becomes
factor Vac which decreases the activity of a particular anticoagulation protein increasing the risk
factor of coagulation.(1)

As the COVID-19 pandemic progressed, studies were conducted on patients who had
COVID-19, yet were still suffering from complications long after having the virus. A study was
conducted from May 1, 2020 to December 31, 2021 to investigate patients suffering from
long-COVID to determine what their main symptoms were, as well as any possible correlation.
Association rule mining techniques were used to sift through 30,327 Twitter tweets that were all
related to long-COVID. The results concluded the most common symptoms of long-COVID are
breathlessness, fatigue, and brain fog, which align with literature from the Mayo Clinic, NHS,
CDC, and WHO.(2) To the surprise of many scientists, those suffering from long-COVID also presented with micro blood clots, which could be exacerbated by having blood clot disorders,
such as FVL.

Patients who had suffered from severe COVID-19 and exhibited factor V activity were
reported to develop deep vein thrombosis or pulmonary embolisms (DVT/PE) at an elevated
rate.3 Since the rapid emergence of COVID-19 more healthcare professionals are beginning to
raise concerns about the elevated presence of blood clotting disorders due to factor V elevation.
In a COVID-19 investigation, 43% of the reported cases for COVID-19 presented an elevated
presence of factor V activity, in turn increasing the risk of developing DVT/PE.(3) Although the
results have yet to be fully determined as significantly correlated, there is still reason to raise
concern and spread awareness for the general public, especially with the use of oral
contraception. This potential correlation can be especially concerning for women, as the risk of
blood clots increases due to the use of birth control.(4) A key component within birth control is
estrogen, which can create an elevated risk of developing blood clots. While taking birth control
the risk of developing a blood clot is minor, but the risk becomes more substantial when women
taking birth control present a history of blood clotting disorders such as FVL.(4) Due to this
elevated risk of blood clots from COVID-19 and oral contraception, it is essential to spread
awareness so the general public. This awareness provides individuals an opportunity to consult
healthcare professionals, receive an evaluation, and make a plan that is specific to their case.

COVID-19 is still an illness that is very new in our world, and there is always more
research to be done. The general public is being put at risk by not knowing the severity of blood
clotting disorders and their effects in conjunction with long-COVID and especially for women,
with taking oral contraceptives. It is essential to inform the public to meet with their doctors and receive necessary screenings to protect their health. By taking preventative measures each person
is able to ensure that they are given the proper quality of life that each individual deserves.

1) Lam, W.; Moosavi, L. Physiology, Factor V. National Library of Medicine 2022.
2) Matharaarachchi, S.; Domaratzki, M.; Katz, A.; Muthukumarana, S. Discovering Long
Covid Symptom Patterns: Association Rule Mining and Sentiment Analysis in Social
Media Tweets. JMIR Formative Research 2022, 6.
3) Stefely, Jonathan A.; Christensen, Bianca B.; Gogakos, Tasos.; Cone Sullivan, Jensyn K.;
Montgomery, Gabriella G.; Barranco, John P.; Van Cott, Elizabeth M. Marked factor V
activity in severe COVID-19 is associated with venous thromboembolism. American
Journal of Hematology 2020, 95.
4) Solymoss, Susan. Risk of venous thromboembolism with oral contraceptives. Canadian
Medical Association Journal 2011, 183.

Photo taken by Ashley Grasinger from the back of an ambulance.