Role of family history in identifying women with thrombophilia and higher risk of venous thromboembolism during oral contraception.
BACKGROUND
Unrecognized thrombophilic defects increase the risk of venous thromboembolism (VTE) in women during oral contraception (OC). We evaluated the sensitivity and specificity of a family history of VTE to identify thrombophilia in women before OC and after venous thrombotic complications during OC.


METHODS
Thrombophilia screening was performed after obtaining a family history by means of a standardized questionnaire in (1) thrombosis-free women before OC and (2) women after an episode of VTE during OC.


RESULTS
We evaluated 479 thrombosis-free women before OC (age range, 15-49 years); family history was positive in 49 (10.2%). Thrombophilic defects were identified in 36 participants (7.5%; 95% confidence interval [CI], 5%-10%), 3 of whom had a positive family history (8.3%). The sensitivity and positive predictive value of family history of thrombophilic defects were 8.3% (95% CI, 2%-22%) and 6.1% (95% CI, 1%-17%), respectively. We also evaluated 189 women after VTE complications during OC (age range, 15-49 years); family history was positive in 48 (25.4%; 95% CI, 19%-32%), 22 of whom had a thrombophilic defect (45.8%; 95% CI, 31%-61%). Thrombophilic defects were identified in 81 women (42.8%; 95% CI, 36%-50%). The sensitivity and positive predictive value of family history of thrombophilic defects were 27.2% (95% CI, 18%-38%) and 45.8% (95% CI, 31%-61%), respectively.


CONCLUSIONS
Family history of VTE has low sensitivity and positive predictive value for identifying women with thrombophilia who are more susceptible to VTE complications during OC.
Division of Angiology, Cardiovascular Department, Unità di Ricerca Clinica sulla Trombofilia Marino Golinelli, University Hospital S. Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. bcosmi@med.unibo.it
Benilde
B
Cosmi
Cristina
C
Legnani
Francesco
F
Bernardi
Sergio
S
Coccheri
Gualtiero
G
Palareti
D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008487:Medical History Taking; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013923:Thromboembolism / Q000139:chemically induced* / Q000235:genetics*; D019851:Thrombophilia / Q000139:chemically induced* / Q000235:genetics*
D003278:Contraceptives, Oral, Hormonal