TromboGene

TromboGene

Genetic Evaluation of Hereditary Thrombophilia

Hereditary Thrombophilia

Thrombophilia is a hemostasis disorder with an increased risk of blood clots or thrombosis. There is a predisposition for thrombosis in veins or arteries due to abnormalities in blood composition, blood flow, or the vascular wall.

Results from various clinical and genetic studies [1, 2] established that hereditary thrombophilia may be caused by insufficient coagulation inhibition from:

genetic alterations that result in natural coagulation inhibitors deficiency;

genetic alterations that lead to an increased level / function of coagulation factors.

10% of the world population can have hereditary thrombophilia.

Pulmonary embolism is the third cause of death.

Hereditary thrombophilia is one of the risk factors for fetal loss and recurrent miscarriage.

The use of oral contraceptives is a well established risk factor for venous thrombosis.

Venous thromboembolism is associated with acute myocardial infarction and stroke.

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TromboGene Genetic Test

TromboGene is an evidence-based genetic test for hereditary thrombophilia from HeartGenetics. TromboGene evaluates the genetic risk for cardio and cerebrovascular diseases, venous thromboembolism, including deep venous thrombosis and pulmonary embolism.

The use of genetic testing for hereditary thrombophilia can be considered in several clinical situations, including the following:

Evaluation of patients that are considered of high risk for thrombosis, e.g. planned major surgery, or estrogen use.

Assessment of the risk for thrombosis in asymptomatic patients, meaning screening for inherited thrombophilia.

Evaluation of pregnancy with or without history of complications, including recurrent pregnancy loss and recurrent early pregnancy loss.

Evaluation of close relatives of patients with documented inherited thrombophilia, or with a clinical and family history that is consistent with an inherited thrombophilia

Selected genes:

Factor V Leiden (F5) and Prothrombin (F2) mutations are associated with coronary artery disease, stroke, pulmonary embolism, fetal loss and increased risk for thromboembolism in women under hormonal therapy [11-18].

MTHFR genetic polymorphisms may be a susceptibility factor that increase the predisposition for vascular thrombosis, stroke, coronary heart disease, and peripheral arterial disease [20-24].

PAI-1 genetic polymorphisms may be associated with an increased risk for deep venous thromboembolism, myocardial infarction, portal vein thrombosis, fetal loss, implantation failure and preeclampsia in the presence of other genetic variants and acquired or modifiable risk factors associated with thrombophilia [25-28].

Protein C receptor mutations are associated with venous and arterial thromboembolism [14,29-32].

Protein S mutations are associated with venous and arterial thromboembolism and fetal loss [14,17,32].

Antithrombin mutations (SERPINC1) are associated with venous thromboembolism and cardiovascular disease [14,32-34].

Fibrinogen beta chain (FGB) mutation may be a susceptibility factor for stroke, venous thrombosis and coronary artery disease if combined with other risk factors [19].

Genetic Panel

TromboGene genetic test evaluates 15 genetic variants in 11 genes.

F2, F5, GP1BA, PROCR, PAI-1, MTHFR, PROS1, SERPINC1, F13A1, F12 and FGB.

International Medical Guidelines

Several international study groups recognize the value of the genetic test to determine the aetiology of hereditary thrombophilia [3,4,7,8,9,10].

Guidelines from Scientific Societies and Working Groups for inherited thrombophilia

The French Consensus Guidelines for venous thromboembolic disease

The National Institute for Health and Clinical Excellence (NICE) for venous thromboembolic diseases

Guideline for the evaluation and treatment of hereditary thrombophilia

Report

The TromboGene genetic report includes a section identified as “Guideline Recommendations”. This section presents guidance from the “Anticoagulation Forum”, taking into account:

> previous thrombotic events;
> family history;
> pregnancy;
> previous fetal loss;
> estrogen use.

Turnaround time

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Scientific Studies

[1] J Genet Couns. 2007. 16(3):261-77.
[2] J Thromb Haemost. 2007. 5 Suppl 1:264-9.
[3] NICE. Clinical guideline 144. London: National Institute for Health and Clinical Excellence, 2012.
[4] Thromb Haemost. 2013. 110(4):697-705.
[5] Br J Haematol. 2008. 143(3):321-35.
[6] Hematology Am Soc Hematol Educ Program. 2005. 1-12.
[7] Int Angiol. 2005. 24(1):1-26.
[8] J Mal Vasc. 2009. 34(3):156-203.
[9] Genetic Testing for Inherited Thrombophilia (MP-2.253), 2014.
[10] J Thromb Thrombolysis. 2016 Jan;41(1):154-64. doi: 10.1007/s11239-015-1316-1.