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Benilde Cosmi, MD; Cristina Legnani, MS; Francesco Bernardi, MS; Sergio Coccheri, MD; Gualtiero Palareti, MD

Arch Intern Med. 2003;163:1105-1109.

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.

Conclusion  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.

From the Division of Angiology, Cardiovascular Department, Unità di Ricerca Clinica sulla Trombofilia "Marino Golinelli," University Hospital S.Orsola-Malpighi, Bologna (Drs Cosmi, Coccheri, and Palareti and Ms Legnani), and Centro di Studi Biochimici del Genoma Umano, Department of Biochemistry and Molecular Biology, University of Ferrara, Ferrara (Mr Bernardi), Italy. The authors have no relevant financial interest in this article.

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