title: Inherited risk factors for venous thromboembolism.
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.
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy.
authors.forename: Ida
authors.initials: I
authors.lastname: Martinelli
authors.affiliation: Institute of Hematology, Catholic University, Largo A. Gemelli 8, I-00168 Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: De Stefano
authors.affiliation: Scientific Direction, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 28, 20122 Milan, Italy.
authors.forename: Pier M
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D020022:Genetic Predisposition to Disease; D014943:Global Health; D006801:Humans; D009017:Morbidity / Q000639:trends; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000235:genetics*