Hereditary Thrombophilia in Trauma Patients with Venous Thromboembolism: Is Routine Screening Necessary?

Background Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), remains a common complication following trauma. The role of hereditary thrombophilia (HT) in post-traumatic VTE is unknown. In the general population with a first-time DVT, Factor V Leiden (FVL) and prothrombin G20210A mutation (PGM) are the most common types of HT with an incidence of 20-25% and 6-18%, respectively. The objective of this study was to identify the incidence of FVL and PGM in post-traumatic VTE to determine whether routine screening for HT in trauma should be performed. Methods We conducted a prospective observational study at our Level I trauma center from 2013 to 2016 when 70 patients with post-traumatic DVT and PE were screened for FVL and PGM. Demographics, injury characteristics and established risk factors for VTE were collected for each patient. Statistical analysis was performed to compare patients with and without HT. Results The incidence of FVL and PGM in post-traumatic VTE was 1.4% and 5.7%, respectively. All HT-positive patients had a DVT and one had an associated PE. Both the individual risk factors and the total number of risk factors for VTE were similar between the HT-positive group and the HT-negative group. Conclusions There was a lower incidence of FVL and PGM in patients with post-traumatic DVT than in patients with a first-time DVT in the general population. HT does not appear to significantly contribute to post-traumatic VTE in our trauma population. Further research is warranted to determine whether routine screening for HT in trauma should be performed. Level of Evidence Level III, epidemiological study Address correspondence to: Michael J. Sise, MD, Trauma Service (MER62), Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA 92103, Email: sise.mike@scrippshealth.org Conflicts of Interest: There are no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs. However, co-author Vishal Bansal, MD, is currently Chief Scientific Officer and co-founder of Oxeia Biopharmaceuticals, Inc. which focuses on drug treatments for concussion. For the remaining co-authors, no conflicts, actual or potential, are declared. Meetings at which paper was presented: None Source of Funding: None © 2017 Lippincott Williams & Wilkins, Inc.

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