ABSTRACT
Over the past 20 years, the landscape with respect to evaluation of thrombophilia, the inherited or acquired tendency to develop venous thromboembolism, has changed dramatically. Increased knowledge regarding the contribution of genetic predisposition to thrombosis has raised several questions regarding screening, diagnosis, and management. In this review, we will examine these issues while providing an update on genetic testing for inherited thrombotic disorders.
KEYWORDS
Thrombophilia - thrombosis - factor V Leiden - prothrombin - genetic testing
REFERENCES
1
Buchanan G S, Rodgers G M, Ware Branch D.
The inherited thrombophilias: genetics, epidemiology, and laboratory evaluation.
Best Pract Res Clin Obstet Gynaecol.
2003;
17
397-411
2
Machin S J.
Pros and cons of thrombophilia testing: cons.
J Thromb Haemost.
2003;
1
412-413
3
Martinelli I.
Pros and cons of thrombophilia testing: pros.
J Thromb Haemost.
2003;
1
410-411
4
Coppens M, van Mourik J A, Eckmann C M, Buller H R, Middeldorp S.
Current practise of testing for inherited thrombophilia.
J Thromb Haemost.
2007;
5
1979-1981
5
Martinelli I.
Rebuttal to: Pros and cons of thrombophilia testing—cons.
J Thromb Haemost.
2003;
1
1311-1312
6
Bauer K A.
Management of thrombophilia.
J Thromb Haemost.
2003;
1
1429-1434
7
Kearon C.
Indefinite anticoagulation after a first episode of unprovoked venous thromboembolism: yes.
J Thromb Haemost.
2007;
5
2330-2335
8
Caprini J A, Glase C J, Anderson C B, Hathaway K.
Laboratory markers in the diagnosis of venous thromboembolism.
Circulation.
2004;
109
I4-I18
9
Wu O, Robertson L, Twaddle S et al..
Screening for thrombophilia in high-risk situations: systematic review and cost-effectiveness analysis. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) study.
Health Technol Assess.
2006;
10
1-110
10
College of American Pathologists Consensus Conference XXXVI: Diagnostic Issues in Thrombophilia.
Arch Pathol Lab Med.
2002;
126
1277-1433
11
Grody W W, Griffin J H, Taylor A K, Korf B R, Heit J A.
American College of Medical Genetics consensus statement on factor V Leiden mutation testing.
Genet Med.
2001;
3
139-148
12
Nicolaides A N, Breddin H K, Carpenter P et al..
Thrombophilia and venous thromboembolism. International consensus statement. Guidelines according to scientific evidence.
Int Angiol.
2005;
24
1-26
13
Geerts W H, Pineo G F, Heit J A et al..
Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
Chest.
2004;
126
338S-400S
14 Laberge A MPB, Hindorff L, Burke W. Use of the genetic test for factor V Leiden in practice and impact on patient management. Presented at: The Annual Meeting of The American Society of Human Genetics October 25, 2007 San Diego, CA; [abstract 813]
15
Bates S M, Greer I A, Hirsh J, Ginsberg J S.
Use of antithrombotic agents during pregnancy: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
Chest.
2004;
126
627S-644S
16
James A H, Abel D E, Brancazio L R.
Anticoagulants in pregnancy.
Obstet Gynecol Surv.
2006;
61
59-69
17
Saukko P M, Richards S H, Shepherd M H, Campbell J L.
Are genetic tests exceptional? Lessons from a qualitative study on thrombophilia.
Soc Sci Med.
2006;
63
1947-1959
18
Hellmann E A, Leslie N D, Moll S.
Knowledge and educational needs of individuals with the factor V Leiden mutation.
J Thromb Haemost.
2003;
1
2335-2339
19
Kamphuisen P W, Rosendaal F R.
Thrombophilia screening: a matter of debate.
Neth J Med.
2004;
62
180-187
20
Eichinger S, Pabinger I, Stumpflen A et al..
The risk of recurrent venous thromboembolism in patients with and without factor V Leiden.
Thromb Haemost.
1997;
77
624-628
21
Kearon C.
Initial treatment of venous thromboembolism.
Thromb Haemost.
1999;
82
887-891
22
Lindmarker P, Schulman S, Sten-Linder M et al..
The risk of recurrent venous thromboembolism in carriers and non-carriers of the G1691A allele in the coagulation factor V gene and the G20210A allele in the prothrombin gene. DURAC Trial Study Group. Duration of Anticoagulation.
Thromb Haemost.
1999;
81
684-689
23
Ridker P M, Goldhaber S Z, Danielson E et al..
Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism.
N Engl J Med.
2003;
348
1425-1434
24
Simioni P, Prandoni P, Lensing A W et al..
The risk of recurrent venous thromboembolism in patients with an Arg506→Gln mutation in the gene for factor V (factor V Leiden).
N Engl J Med.
1997;
336
399-403
25
De Stefano V, Martinelli I, Mannucci P M et al..
The risk of recurrent deep venous thrombosis among heterozygous carriers of both factor V Leiden and the G20210A prothrombin mutation.
N Engl J Med.
1999;
341
801-806
26
Makris M, Rosendaal F R, Preston F E.
Familial thrombophilia: genetic risk factors and management.
J Intern Med Suppl.
1997;
740
9-15
27
Zoller B, Berntsdotter A, Garcia de Frutos P, Dahlback B.
Resistance to activated protein C as an additional genetic risk factor in hereditary deficiency of protein S.
Blood.
1995;
85
3518-3523
28
Nowak-Gottl U, Junker R, Kreuz W et al..
Risk of recurrent venous thrombosis in children with combined prothrombotic risk factors.
Blood.
2001;
97
858-862
29
Stark J E, Kilzer W J.
Venous thromboembolic prophylaxis in hospitalized medical patients.
Ann Pharmacother.
2004;
38
36-40
30
Brill-Edwards P, Ginsberg J S, Gent M et al..
Safety of withholding heparin in pregnant women with a history of venous thromboembolism. Recurrence of Clot in This Pregnancy Study Group.
N Engl J Med.
2000;
343
1439-1444
31
Dizon-Townson D, Miller C, Sibai B et al..
The relationship of the factor V Leiden mutation and pregnancy outcomes for mother and fetus.
Obstet Gynecol.
2005;
106
517-524
32
Ginsberg J S, Kowalchuk G, Hirsh J, Brill-Edwards P, Burrows R.
Heparin therapy during pregnancy. Risks to the fetus and mother.
Arch Intern Med.
1989;
149
2233-2236
33
Vandenbroucke J P, Koster T, Briet E et al..
Increased risk of venous thrombosis in oral-contraceptive users who are carriers of factor V Leiden mutation.
Lancet.
1994;
344
1453-1457
34
Martinelli I, Taioli E, Bucciarelli P, Akhavan S, Mannucci P M.
Interaction between the G20210A mutation of the prothrombin gene and oral contraceptive use in deep vein thrombosis.
Arterioscler Thromb Vasc Biol.
1999;
19
700-703
35 FDA News .FDA approves update to label on birth control patch. January 18, 2008. Available at: http://www.fda.gov/bbs/topics/NEWS/2008/NEW0178/.html Accessed November 10, 2008
36
Brenner B R, Nowak-Gottl U, Kosch A, Manco-Johnson M, Laposata M.
Diagnostic studies for thrombophilia in women on hormonal therapy and during pregnancy, and in children.
Arch Pathol Lab Med.
2002;
126
1296-1303
37
Bank I, Scavenius M P, Buller H R, Middeldorp S.
Social aspects of genetic testing for factor V Leiden mutation in healthy individuals and their importance for daily practice.
Thromb Res.
2004;
113
7-12
38
Reich L M, Bower M, Key N S.
Role of the geneticist in testing and counseling for inherited thrombophilia.
Genet Med.
2003;
5
133-143
39 Kitchens C S, Alving B M, Kessler C M. Consultative Hemostasis and Thrombosis. Philadelphia, PA; W.B. Saunders 2002: 181-196
40
Egeberg O.
Inherited antithrombin deficiency causing thrombophilia.
Thromb Diath Haemorrh.
1965;
13
516-530
41 Schafer A I, Levine M N, Konkle B A, Kearon C. Thrombotic disorders: diagnosis and treatment. Presented at: the American Society of Hematology 2003 annual conference Available at: http://asheducationbook.hematologylibrary.org
42
Olds R J, Lane D A, Chowdhury V et al..
Complete nucleotide sequence of the antithrombin gene: evidence for homologous recombination causing thrombophilia.
Biochemistry.
1993;
32
4216-4224
43
Lane D A, Bayston T, Olds R J et al..
Antithrombin mutation database: 2nd (1997) update. For the Plasma presented at: the Coagulation Inhibitors Subcommittee of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis.
Thromb Haemost.
1997;
77
197-211
44
Bick R L.
Prothrombin G20210A mutation, antithrombin, heparin cofactor II, protein C, and protein S defects.
Hematol Oncol Clin North Am.
2003;
17
9-36
45
Hirsh J, Piovella F, Pini M.
Congenital antithrombin III deficiency. Incidence and clinical features.
Am J Med.
1989;
87
34S-38S
46
Kottke-Marchant K, Duncan A.
Antithrombin deficiency: issues in laboratory diagnosis.
Arch Pathol Lab Med.
2002;
126
1326-1336
47
Martinelli I, Mannucci P M, De Stefano V et al..
Different risks of thrombosis in four coagulation defects associated with inherited thrombophilia: a study of 150 families.
Blood.
1998;
92
2353-2358
48
Nakase H, Kawasaki T, Itani T et al..
Budd-Chiari syndrome and extrahepatic portal obstruction associated with congenital antithrombin III deficiency.
J Gastroenterol.
2001;
36
341-345
49
Bauer K A.
Management of patients with hereditary defects predisposing to thrombosis including pregnant women.
Thromb Haemost.
1995;
74
94-100
50
Tiede A, Tait R C, Shaffer D W et al..
Antithrombin alfa in hereditary antithrombin deficient patients: a phase 3 study of prophylactic intravenous administration in high risk situations.
Thromb Haemost.
2008;
99
616-622
51
Crowther M A, Kelton J G.
Congenital thrombophilic states associated with venous thrombosis: a qualitative overview and proposed classification system.
Ann Intern Med.
2003;
138
128-134
52
Griffin J H, Evatt B, Zimmerman T S, Kleiss A J, Wideman C.
Deficiency of protein C in congenital thrombotic disease.
J Clin Invest.
1981;
68
1370-1373
53
Reitsma P H, Bernardi F, Doig R G et al..
Protein C deficiency: a database of mutations, 1995 update. On behalf of the Subcommittee on Plasma Coagulation Inhibitors of the Scientific and Standardization Committee of the ISTH.
Thromb Haemost.
1995;
73
876-889
54
Franchini M, Veneri D, Salvagno G L, Manzato F, Lippi G.
Inherited thrombophilia.
Crit Rev Clin Lab Sci.
2006;
43
249-290
55
Koster T, Rosendaal F R, Briet E et al..
Protein C deficiency in a controlled series of unselected outpatients: an infrequent but clear risk factor for venous thrombosis (Leiden Thrombophilia Study).
Blood.
1995;
85
2756-2761
56
McGehee W G, Klotz T A, Epstein D J, Rapaport S I.
Coumarin necrosis associated with hereditary protein C deficiency.
Ann Intern Med.
1984;
101
59-60
57
Schwarz H P, Fischer M, Hopmeier P, Batard M A, Griffin J H.
Plasma protein S deficiency in familial thrombotic disease.
Blood.
1984;
64
1297-1300
58
Simmonds R E, Zoller B, Ireland H et al..
Genetic and phenotypic analysis of a large (122-member) protein S-deficient kindred provides an explanation for the familial coexistence of type I and type III plasma phenotypes.
Blood.
1997;
89
4364-4370
59
Gandrille S, Borgel D, Sala N et al..
Protein S deficiency: a database of mutations—summary of the first update.
Thromb Haemost.
2000;
84
918
60
Bertina R M, Koeleman B P, Koster T et al..
Mutation in blood coagulation factor V associated with resistance to activated protein C.
Nature.
1994;
369
64-67
61
Koster T, Rosendaal F R, de Ronde H et al..
Venous thrombosis due to poor anticoagulant response to activated protein C: Leiden Thrombophilia Study.
Lancet.
1993;
342
1503-1506
62
Rosendaal F R, Koster T, Vandenbroucke J P, Reitsma P H.
High risk of thrombosis in patients homozygous for factor V Leiden (activated protein C resistance).
Blood.
1995;
85
1504-1508
63
Rees D C, Cox M, Clegg J B.
World distribution of factor V Leiden.
Lancet.
1995;
346
1133-1134
64
Williamson D, Brown K, Luddington R, Baglin C, Baglin T, Factor V.
Cambridge: a new mutation (Arg306→Thr) associated with resistance to activated protein C.
Blood.
1998;
91
1140-1144
65
Norstrom E, Thorelli E, Dahlback B.
Functional characterization of recombinant FV Hong Kong and FV Cambridge.
Blood.
2002;
100
524-530
66
Bernardi F, Faioni E M, Castoldi E et al..
A factor V genetic component differing from factor V R506Q contributes to the activated protein C resistance phenotype.
Blood.
1997;
90
1552-1557
67
de Visser M C, Guasch J F, Kamphuisen P W et al..
The HR2 haplotype of factor V: effects on factor V levels, normalized activated protein C sensitivity ratios and the risk of venous thrombosis.
Thromb Haemost.
2000;
83
577-582
68
Castaman G, Faioni E M, Tosetto A, Bernardi F.
The factor V HR2 haplotype and the risk of venous thrombosis: a meta-analysis.
Haematologica.
2003;
88
1182-1189
69
Poort S R, Rosendaal F R, Reitsma P H, Bertina R M.
A common genetic variation in the 3′-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis.
Blood.
1996;
88
3698-3703
70
Kyrle P A, Mannhalter C, Beguin S et al..
Clinical studies and thrombin generation in patients homozygous or heterozygous for the G20210A mutation in the prothrombin gene.
Arterioscler Thromb Vasc Biol.
1998;
18
1287-1291
71
Franco R F, Santos S E, Elion J, Tavella M H, Zago M A.
Prevalence of the G20210A polymorphism in the 3′-untranslated region of the prothrombin gene in different human populations.
Acta Haematol.
1998;
100
9-12
72
McGlennen R C, Key N S.
Clinical and laboratory management of the prothrombin G20210A mutation.
Arch Pathol Lab Med.
2002;
126
1319-1325
73
Haverkate F, Samama M.
Familial dysfibrinogenemia and thrombophilia. Report on a study of the SSC Subcommittee on Fibrinogen.
Thromb Haemost.
1995;
73
151-161
74 Martinez J, Ferber A. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, PA; Churchill Livingstone 2005: 2097-2109
75
Asselta R, Duga S, Tenchini M L.
The molecular basis of quantitative fibrinogen disorders.
J Thromb Haemost.
2006;
4
2115-2129
76
Cunningham M T, Brandt J T, Laposata M, Olson J D.
Laboratory diagnosis of dysfibrinogenemia.
Arch Pathol Lab Med.
2002;
126
499-505
77
Perry I J, Refsum H, Morris R W et al..
Prospective study of serum total homocysteine concentration and risk of stroke in middle-aged British men.
Lancet.
1995;
346
1395-1398
78
Selhub J, Jacques P F, Bostom A G et al..
Association between plasma homocysteine concentrations and extracranial carotid-artery stenosis.
N Engl J Med.
1995;
332
286-291
79
Stampfer M J, Malinow M R, Willett W C et al..
A prospective study of plasma homocyst(e)ine and risk of myocardial infarction in US physicians.
JAMA.
1992;
268
877-881
80
den Heijer M, Koster T, Blom H J et al..
Hyperhomocysteinemia as a risk factor for deep-vein thrombosis.
N Engl J Med.
1996;
334
759-762
81
Pereira A C, Schettert I T, Morandini Filho A A, Guerra-Shinohara E M, Krieger J E.
Methylenetetrahydrofolate reductase (MTHFR) c677t gene variant modulates the homocysteine folate correlation in a mild folate-deficient population.
Clin Chim Acta.
2004;
340
99-105
82
Moll S.
Thrombophilias–practical implications and testing caveats.
J Thromb Thrombolysis.
2006;
21
7-15
83
Esfahani S T, Cogger E A, Caudill M A.
Heterogeneity in the prevalence of methylenetetrahydrofolate reductase gene polymorphisms in women of different ethnic groups.
J Am Diet Assoc.
2003;
103
200-207
84
Domagala T B, Adamek L, Nizankowska E, Sanak M, Szczeklik A.
Mutations C677T and A1298C of the 5,10-methylenetetrahydrofolate reductase gene and fasting plasma homocysteine levels are not associated with the increased risk of venous thromboembolic disease.
Blood Coagul Fibrinolysis.
2002;
13
423-431
85
Kluijtmans L A, den Heijer M, Reitsma P H et al..
Thermolabile methylenetetrahydrofolate reductase and factor V Leiden in the risk of deep-vein thrombosis.
Thromb Haemost.
1998;
79
254-258
86
Koster T, Blann A D, Briet E, Vandenbroucke J P, Rosendaal F R.
Role of clotting factor VIII in effect of von Willebrand factor on occurrence of deep-vein thrombosis.
Lancet.
1995;
345
152-155
87
Kamphuisen P W, Houwing-Duistermaat J J, van Houwelingen H C et al..
Familial clustering of factor VIII and von Willebrand factor levels.
Thromb Haemost.
1998;
79
323-327
88
Kamphuisen P W, Eikenboom J C, Bertina R M.
Elevated factor VIII levels and the risk of thrombosis.
Arterioscler Thromb Vasc Biol.
2001;
21
731-738
89
Girolami A, Randi M L, Gavasso S, Lombardi A M, Spiezia F.
The occasional venous thromboses seen in patients with severe (homozygous) FXII deficiency are probably due to associated risk factors: a study of prevalence in 21 patients and review of the literature.
J Thromb Thrombolysis.
2004;
17
139-143
90
Soria J M, Almasy L, Souto J C et al..
A quantitative-trait locus in the human factor XII gene influences both plasma factor XII levels and susceptibility to thrombotic disease.
Am J Hum Genet.
2002;
70
567-574
91
Endler G, Exner M, Mannhalter C et al..
A common C→T polymorphism at nt 46 in the promoter region of coagulation factor XII is associated with decreased factor XII activity.
Thromb Res.
2001;
101
255-260
92
Sprengers E D, Kluft C.
Plasminogen activator inhibitors.
Blood.
1987;
69
381-387
93
Eriksson P, Kallin B, van 't Hooft F M, Bavenholm P, Hamsten A.
Allele-specific increase in basal transcription of the plasminogen-activator inhibitor 1 gene is associated with myocardial infarction.
Proc Natl Acad Sci U S A.
1995;
92
1851-1855
94
Tsantes A E, Nikolopoulos G K, Bagos P G et al..
Association between the plasminogen activator inhibitor-1 4G/5G polymorphism and venous thrombosis. A meta-analysis.
Thromb Haemost.
2007;
97
907-913
95
Endler G, Mannhalter C.
Polymorphisms in coagulation factor genes and their impact on arterial and venous thrombosis.
Clin Chim Acta.
2003;
330
31-55
96
Hoppe B, Tolou F, Dorner T, Kiesewetter H, Salama A.
Gene polymorphisms implicated in influencing susceptibility to venous and arterial thromboembolism: frequency distribution in a healthy German population.
Thromb Haemost.
2006;
96
465-470
97
Sykes T C, Fegan C, Mosquera D.
Thrombophilia, polymorphisms, and vascular disease.
Mol Pathol.
2000;
53
300-306
98
Bezemer I D, Bare L A, Doggen C J et al..
Gene variants associated with deep vein thrombosis.
JAMA.
2008;
299
1306-1314
99
Bovill E G.
Gene discovery in venous thrombosis: progress and promise.
JAMA.
2008;
299
1362-1363
100
Adams M, Ward C, Thom J et al..
Emerging technologies in hemostasis diagnostics: a report from the Australasian Society of Thrombosis and Haemostasis Emerging Technologies Group.
Semin Thromb Hemost.
2007;
33
226-234
Elizabeth A VargaM.S.
The Research Institute at Nationwide Children's Hospital
700 Children's Dr., Wexner - 4th Floor, Columbus, OH 43205
eMail: Elizabeth.Varga@Nationwidechildrens.org