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 Blood, 1 October 2005, Vol. 106, No. 7, pp. 2363-2365.
Prepublished online as a Blood First Edition Paper on June 16, 2005; DOI 10.1182/blood-2005-04-1461.

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HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
Brief report

An underestimated combination of opposites resulting in enhanced thrombotic tendency

Paolo Simioni, Elisabetta Castoldi, Barbara Lunghi, Daniela Tormene, Jan Rosing, and Francesco Bernardi

From the Department of Medical and Surgical Sciences, Second Chair of Internal Medicine, University of Padua Medical School, Padua, Italy; the Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands; and the Department of Biochemistry and Molecular Biology, University of Ferrara, Ferrara, Italy.

Heterozygous carriers of factor V (FV) Leiden who also carry FV deficiency often develop venous thromboembolism, but the thrombosis risk associated with this rare condition (pseudohomozygous activated protein C resistance) is still unclear. The thrombosis risk of genetically characterized pseudohomozygotes (n = 6) was compared with that of FV Leiden heterozygotes (n = 683) and homozygotes (n = 50) recruited within a large cohort study on familial thrombophilia. Both thrombin generation and Kaplan-Meier thrombosis-free survival analyses were performed in different FV genotype groups. FV Leiden pseudohomozygotes showed significantly higher thrombosis risk than heterozygotes. The thrombin generation test in pseudohomozygotes showed a pattern similar to homozygotes. Accordingly, early thrombotic manifestations occurred in pseudohomozygotes at a similar rate as in homozygotes. Thus, failure to recognize FV deficiency in FV Leiden heterozygotes may result in an underestimate of the thrombosis risk and inadequate management of affected patients.


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