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Implications for Venous Thromboembolism Screening

Paul M. Ridker, MD; Joseph P. Miletich, MD; Charles H. Hennekens, MD; Julie E. Buring, MD

JAMA. 1997;277(16):1305-1307.

Abstract
Objective.
—To estimate ethnic-specific prevalence rates of factor V Leiden, an inherited defect of hemostasis associated with risk of venous thrombosis.

Design.
—Survey of 4047 American men and women participating in the Physicians' Health Study (PHS) or in the Women's Health Study (WHS). All study participants were free of myocardial infarction, stroke, or venous thrombosis.

Main Outcome Measure.
—Prevalence of G1691A Leiden mutation in the gene coding for coagulation factor V was determined in the PHS group using polymerase chain reaction techniques and, in the WHS group, a second-generation activated protein C (APC)—resistance screening test with genetic confirmation of all borderline and low-value results.

Results.
—In 2468 Caucasian Americans, carrier frequency of factor V Leiden was 5.27% (95% confidence interval [CI], 4.42%-6.22%). Carrier frequency was 2.21% in 407 Hispanic Americans, 1.23% in 650 African Americans, 0.45% in 442 Asian Americans, and 1.25% in 80 Native Americans. Thus, prevalence of factor V Leiden was less among minority subjects (P=.001). Carrier frequencies were similar in Caucasian men and women (5.53% vs 4.85% respectively, P=.5).

Conclusion.
—These data indicate that prevalence of factor V Leiden is greater among Caucasians than minority Americans. These data have implications for clinicians considering whether to screen for factor V Leiden in high-risk groups such as those with prior venous thromboses or coexistent defects of anticoagulation and women at risk for postpartum thrombosis or seeking oral contraceptives.

Author Affiliations
From the Divisions of Preventive Medicine (Drs Ridker, Hennekens, and Buring) and Cardiovascular Diseases (Dr Ridker), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School; the Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Mass (Drs Hennekens and Buring); and the Division of Laboratory Medicine, Washington University School of Medicine, St Louis, Mo (Dr Miletich).

Footnotes
Corresponding author: Paul M. Ridker, MD, Brigham and Women's Hospital, 900 Commonwealth Ave E, Boston, MA 02215-1204 (e-mail: pmridker@bics.bwh. harvard.edu).

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