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Prothrombin 20210A Mutation
A Mild Risk Factor for Venous Thromboembolism but Not for Arterial Thrombotic Disease and Pregnancy-Related Complications in a Family Study
Ivan Bank, MD, PhD;
Eduard J. Libourel, MD;
Saskia Middeldorp, MD, PhD;
Elisabeth C. M. van Pampus, MD, PhD;
Maria M. W. Koopman, MD, PhD;
Karly Hamulyák, MD, PhD;
Martin H. Prins, MD, PhD;
Jan van der Meer, MD, PhD;
Harry R. Büller, MD, PhD
Arch Intern Med. 2004;164:1932-1937.
Background The prothrombin 20210A mutation has been associated with an increased risk of venous thromboembolism (VTE). Its relationship with arterial disease and pregnancy-related complications is, however, still uncertain. The aim of this study was to estimate the incidences of first venous and arterial thrombotic events and pregnancy-related complications in relatives of patients with the mutation.
Methods After clinical classification, the presence of the mutation was determined in first-degree relatives of consecutive patients with the mutation and a history of VTE or premature atherosclerosis. Relatives with and without the mutation were compared.
Results Of all relatives, 204 (50%) were heterozygous, 5 were homozygous, and 198 had a normal genotype. The annual incidence of a first episode of VTE was 0.35% and 0.18% in carriers and noncarriers, respectively (odds ratio [OR], 1.9; 95% confidence interval [CI], 0.9-4.1); the annual incidence of a first arterial thrombosis was 0.22% and 0.15% in carriers and noncarriers, respectively (OR, 2.3; 95% CI, 0.8-6.3). The annual incidence of a first myocardial infarction was 0.14% (95% CI, 0.05%-0.23%) and 0.05% (0.01%-0.14%) in carriers and noncarriers, respectively (OR, 4.7; 95% CI, 1.0-22.5; P = .06). In particular, homozygous carriers were at increased risk of VTE (OR, 6.0; 95% CI, 1.3-27.2), whereas a history of VTE in the proband influenced the risk of VTE in the relatives. Women with the mutation did not experience significantly more pregnancy-related complications than their relatives with a normal genotype.
Conclusions The prothrombin mutation is a mild risk factor for VTE within families of carriers but does not seem to play an important role in arterial thrombotic disease, with the exception of myocardial infarction, or in pregnancy-related complications.
From the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (Drs Bank, Middeldorp, Koopman, and Büller); Division of Haemostasis, Thrombosis, and Rheology, Department of Hematology, University Hospital Groningen, Groningen, the Netherlands (Drs Libourel and van der Meer); and Departments of Hematology (Drs van Pampus and Hamulyák), and Clinical Epidemiology and Medical Technology Assessment (Dr Prins), University Hospital of Maastricht, Maastricht, the Netherlands. The authors have no relevant financial interest in this article.
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