Dual thrombophilic disorder presenting as recurrent myocardial infarction in a young male: apla with factor v leiden mutation

Background: Antiphospholipid syndrome (APS) and Factor V Leiden mutation are independent thrombophilic disorders predisposing to arterial and venous thrombosis. Their coexistence significantly amplifies thrombotic risk. Myocardial infarction (MI) is an uncommon presentation of APS, and recurrent MI in association with dual thrombophilia is exceedingly rare. Case Presentation: A 41-year-old male presented with acute-onset retrosternal chest pain radiating to the left arm, accompanied by vomiting. He had a prior history of ST-elevation myocardial infarction (STEMI) one month earlier. Laboratory investigations revealed elevated cardiac biomarkers and severe renal and hepatic dysfunction. Thrombophilia profile confirmed dual positivity for antiphospholipid antibodies (IgG and IgM) with positive lupus anticoagulant, along with Factor V Leiden mutation detected by PCR. Echocardiography demonstrated severe left ventricular systolic dysfunction (LVEF 15–20%) with moderate mitral and tricuspid regurgitation. The patient was managed with dual antiplatelet therapy, anticoagulation, statins, and supportive care, followed by transition to long-term warfarin therapy targeting INR 3. Discussion: The coexistence of APS and Factor V Leiden mutation represents a synergistic prothrombotic state leading to recurrent arterial events even in young individuals without conventional cardiovascular risk factors. The case emphasizes the need for comprehensive thrombophilia screening in young patients presenting with unexplained arterial thrombosis. Conclusion: Dual thrombophilic disorders such as APS with Factor V Leiden mutation markedly increase thrombotic risk and may manifest as recurrent myocardial infarction in young adults. Early recognition and lifelong anticoagulation are crucial to prevent recurrence and improve outcomes. Keywords: Antiphospholipid syndrome, Factor V Leiden mutation, recurrent myocardial infarction, dual thrombophilia, young adult, warfarin.