Factor V Leiden thrombophilia with acute pulmonary embolism in an operated arthroscopic anterior cruciate ligament with medial cruciate ligament reconstruction: A rare case report

The Factor V Leiden (FVL) mutation is a common genetic thrombophilia primarily affecting individuals of Caucasian descent. The heterozygous variation is frequently associated with a significantly increased risk of venous thromboembolism. This document presents a unique case of acute pulmonary embolism (PE) in a young child with a heterozygous FVL mutation following arthroscopic anterior cruciate ligament (ACL) surgery. A 35-year-old male with no prior thrombotic history underwent arthroscopic ACL and medial cruciate ligament (MCL) reconstruction and arrived 1 week postoperatively with significant dyspnea and altered mental status. He was diagnosed with cardiac arrest and severe bilateral PE. The patient was administered intravenous tenecteplase for thrombolysis and thereafter admitted to the intensive care unit. The analysis of the FVL mutation identified a heterozygous mutation, with no additional significant thrombophilic mutations seen. Apixaban was administered for extended anticoagulation after stabilization. The patient demonstrated consistent clinical progress and was discharged in a stable condition with advisories for ongoing renal management and hematologic surveillance. This case report underscores the importance of assessing hereditary thrombophilia in post-operative thrombotic events, even in low-risk patients, and demonstrates the critical role of prompt identification and early management in improving outcomes.