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Clinical Investigations: PULMONARY VASCULATURE |

Inherited Thrombophilic Risk Factors and Venous Thromboembolism*: Distinct Role in Peripheral Deep Venous Thrombosis and Pulmonary Embolism

Maurizio Margaglione, MD; Vincenzo Brancaccio, MD; Domenico De Lucia, MD; Ida Martinelli, MD, PhD; Antonio Ciampa, MD; Elvira Grandone, MD; Giovanni Di Minno, MD
Author and Funding Information

*From the Unita’ di Aterosclerosi e Trombosi (Drs. Margaglione and Grandone), Istituto di Ricovera e Cura a Carattere Scientifico “Casa Sollievo della Sofferenza,” S. Giovanni Rotondo; Divisione di Ematologia (Dr. Brancaccio), Unità di Coagulazione, Ospedale “A. Cardarelli,” Napoli; Istituto di Patologia Generale e Oncologia (Dr. De Lucia), Seconda Università di Napoli; Centro Emofilia e Trombosi “A. Bianchi Bonomi” (Dr. Martinelli), IRCCS Ospedale Maggiore, Università di Milano, Milan; Divisione di Ematologia (Dr. Ciampa), Ospedale “G. Moscati,” Avellino; and Istituto di Medicina Interna e Geriatria (Dr. Di Minno), Università di Palermo, Palermo, Italy.

Correspondence to: Maurizio Margaglione, MD, Unità di Aterosclerosi e Trombosi, IRCCS “Casa Sollievo della Sofferenza,” viale Cappuccini, San Giovanni Rotondo (FG) 71013, Italy; e-mail: ate.tro@operapadrepio.it



Chest. 2000;118(5):1405-1411. doi:10.1378/chest.118.5.1405
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Study objectives: To investigate whether the FII A20210 mutation is associated with isolated pulmonary embolism (PE).

Design: Case-control study.

Setting: Five thrombosis centers in southern Italy.

Patients: Six hundred forty-seven consecutive referred patients with objectively documented venous thrombosis and 1,329 control subjects.

Measurements and results: Medical histories were collected. The G-to-A transition at nucleotide 1691 within the factor V gene (FV Leiden) and the G-to-A transition at nucleotide position 20210 within the prothrombin gene locus (FII A20210), levels of anticoagulant factors, and levels of antiphospholipid antibodies were determined by standard techniques. Patients with deep venous thrombosis (DVT) of the lower extremities (n = 346) or with additional PEs (n = 175) showed similar prevalences of FV Leiden mutation (24.3% and 16.6%, respectively) and FII A20210 mutation (14.2% and 12.6%, respectively), and similar deficiencies of natural anticoagulants (4.9% and 2.3%, respectively). In both groups, the frequencies of FV Leiden and/or FII A20210 mutation were higher than those observed among 1,329 apparently healthy control subjects (4.8% and 4.4%, respectively; p < 0.0001). Among patients with isolated PE (n = 126), prevalences of FV Leiden (7.1%) and FII A20210 mutation (8.7%) were similar to those of control subjects. Inherited thrombophilic abnormalities were less frequent among patients with PE only (15.6%) than among those with DVT only (37.0%; p < 0.001) or whose conditions were complicated by PE (28.0%; p = 0.020). Adjusting for age and sex, FV Leiden mutation , FII A20210 mutation, or both mutations were associated with DVT with PE (FV Leiden mutation: odds ratio [OR], 3.0; 95% confidence interval [CI], 1.6 to 5.5; FII A20210 mutation: OR, 2.6; 95% CI, 1.3 to 5.2; and both mutations: OR, 82.1; 95% CI, 7.5 to 901.2) or without PE (FV Leiden mutation: OR, 6.1; 95% CI, 4.0 to 9.3; FII A20210 mutation: OR, 2.8; 95% CI, 1.7 to 4.8; and both mutations: OR, 167.5; 95% CI, 21.6 to 1,297.7), but not with isolated PE (FV Leiden mutation: OR, 1.2; 95% CI, 0.5 to 2.8; FII A20210 mutation: OR, 1.2; 95% CI, 0.5 to 3.1; and both mutations: OR, 22.1; 95% CI, 1.3 to 370.2).

Conclusions: FII A20210 mutation is associated with DVT in the lower extremities alone or when complicated by PE, but it is not associated with isolated PE.


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