Inherited risk factors for venous thromboembolism

Ida Martinelli, Valerio De Stefano, Pier M. Mannucci

Research output: Contribution to journalArticle

Abstract

Venous thromboembolism (VTE) has important heritable components. In the past 20 years, knowledge in this field has greatly increased with the identification of a number of gene variants causing hypercoagulability. The two main mechanisms are loss-of-function of anticoagulant proteins and gain-of-function of procoagulants, the latter owing to increased synthesis or impaired downregulation of a normal protein or, more rarely, to synthesis of a functionally hyperactive molecule. Diagnosis of thrombophilia is useful to determine the causes of VTE, recognizing that this multifactorial disease can also be influenced by various acquired factors including cancer, surgery, trauma, prolonged immobilization, or reproduction-associated risk factors. Diagnosis of inherited thrombophilia rarely affects the acute or long-term management of VTE. However, the risk of recurrent VTE is increased in anticoagulant-deficient patients and in homozygotes for gain-of-function mutations. Screening for inherited thrombophilia in thrombosis-free individuals is indicated only for relatives of a proband who is anticoagulant-deficient or has a family history of VTE. In families with thrombophilia and VTE, primary antithrombotic prophylaxis during risk situations lowers the rate of incident VTE. In this Review, we discuss the main causes of inherited thrombophilia, the associated clinical manifestations, and the implications for antithrombotic prophylaxis in the affected individuals.

Original languageEnglish
Pages (from-to)140-156
Number of pages17
JournalNature Reviews Cardiology
Volume11
Issue number3
DOIs
Publication statusPublished - Mar 2014

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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