Can family history predict risk of thrombosis?

Abstract

Increased risk of thrombosis can lead to important medical complications including thrombotic stroke. Several genetic factors have been identified that predispose to increased risk of thrombosis. When genetic factors are suspected, it is often assumed that a positive family history will be useful in determining which patients deserve further workup. In this issue of The Journal, Johal et al evaluated family history as a screen for genetic prothrombotic risk factors in children with stroke. They found that family history was not associated with factor V Leiden or prothrombin G20210A mutations. A positive family history had a positive predictive value of only 23% and a negative predictive value of 89%. Clearly, family history has some weaknesses as a predictor in this setting. All children with stroke or other thrombotic episodes should have a workup for prothrombotic genetic abnormalities regardless of family history. Increased risk of thrombosis can lead to important medical complications including thrombotic stroke. Several genetic factors have been identified that predispose to increased risk of thrombosis. When genetic factors are suspected, it is often assumed that a positive family history will be useful in determining which patients deserve further workup. In this issue of The Journal, Johal et al evaluated family history as a screen for genetic prothrombotic risk factors in children with stroke. They found that family history was not associated with factor V Leiden or prothrombin G20210A mutations. A positive family history had a positive predictive value of only 23% and a negative predictive value of 89%. Clearly, family history has some weaknesses as a predictor in this setting. All children with stroke or other thrombotic episodes should have a workup for prothrombotic genetic abnormalities regardless of family history.