Do we need more guidance on thrombophilia testing? Challenges and special considerations

INTRODUCTION

Thrombophilia testing (TT) is a laboratory procedure designed to detect the risk factors involved in the pathogenesis of vascular occlusions. The role of TT is also controversial because it has a limited impact on the choice and duration of antithrombotic treatments.

AREAS COVERED

We reviewed, by examining MEDLINE up to October 2023. Accepted and not accepted thrombophilia markers are discussed along with the appropriateness or not of prescribing TT in several conditions such as: provoked and unprovoked venous thromboembolism (VTE), women who are planning a pregnancy whose relatives had VTE or have a hereditary thrombophilia, before assumption of estro-progestins, after multiple pregnant loss, arterial thrombosis, retinal vein occlusion, and splanchnic vein thrombosis.

EXPERT OPINION

TT is not essential in the management of VTE, but it may be useful for limiting adverse events in case of thrombophilia. We expose our criticism of items afforded by other guidelines by presenting our opinion based on both the scientific evidence and clinical practice. We also deal with common mistakes in prescribing and interpretations of TT hoping to purpose an educational approach on this topic. Finally, we emphasize the creation of the expert in hemostasis and thrombosis who should be present in every hospital.

Spatio-temporal dynamics of pathogenic variants associated with monogenic disorders reconstructed with ancient DNA

Genetic disease burden in ancient communities has barely been evaluated despite an ever expanding body of ancient genomes becoming available. In this study, we inspect 2729 publicly available ancient genomes (100 BP—52000 BP) for the presence of pathogenic variants in 32643 disease-associated loci. We base our subsequent analyses on 19 variants in seven genes—PAH, EDAR, F11, HBB, LRRK2, SLC12A6 and MAOA, associated with monogenic diseases and with well-established pathogenic impact in contemporary populations. We determine 230 homozygote genotypes of these variants in the screened 2729 ancient DNA samples. Eleven of these are in the PAH gene (126 ancient samples in total), a gene associated with the condition phenylketonuria in modern populations. The variants examined seem to show varying dynamics over the last 10000 years, some exhibiting a single upsurge in frequency and subsequently disappearing, while others maintain high frequency levels (compared to contemporary population frequencies) over long time periods. The geographic distribution and age of the ancient DNA samples with established pathogenic variants suggests multiple independent origin of these variants. Comparison of estimates of the geographic prevalence of these variants from ancient and contemporary data show discontinuity in their prevalence and supports their recurrent emergence. The oldest samples in which a variant is established might give an indication of their age and place origin, and an EDAR gene pathogenic variant was established in a sample estimated to be 33210–32480 calBCE. Knowledge about the historical prevalence of variants causing monogenic disorders provides insight on their emergence, dynamics and spread.

The Role of Factor V Leiden in Adult Patients With Venous Thromboembolism: A Meta-Analysis of Published Studies from Turkey

Factor V Leiden (FVL) is the most common inherited risk factor for venous thromboembolism (VTE). The frequency of FVL in patients with VTE has been reported from different parts of Turkey. A meta-analysis was performed to estimate the risk of VTE associated with FVL in Turkish population. Published studies were retrieved from Pubmed and Science Citation Index/Expanded. We selected studies comparing the prevalence of FVL in patients with VTE with controls. The analysis was performed by the software comprehensive meta-analysis. The analysis consisted of 10 studies including 1202 patients with VTE and 1283 controls. The pooled frequency of FVL was significantly higher in patients with VTE (22.8%) than controls (7.6%). The pooled odds ratio (OR) was 3.4 (95% confidence interval [CI], 2.6-4.5). The study showed homogeneity ( Q value, 9.955). No publication bias was observed in any comparison model. Our meta-analysis showed an association of FVL with VTE in Turkey.