Objective:
To investigate the prevalence of thrombotic events among patients with
proven or highly probable homozygosis for the Arg304Gln (Factor VII Padua) defect or compound
heterozygosis containing the Arg304Gln mutation.
Methods:
Homozygotes and compound heterozygotes proven by molecular studies to have the
Arg304Gln mutation were gathered from personal files and from two PubMed searches. In addition,
patients with probable homozygosis on the basis of clotting tests (discrepancies among Factor VII
activity levels according to the tissue thromboplastin used) were also gathered.
Results:
30 proven homozygotes and 17 probable ones were gathered together with 8 compound
heterozygotes. In the latter use, the associated mutation was Cys135Arg (twice), Gly180Arg,
Arg304Trp, Arg315Trp, His348Gln, Gly365Cys. The prevalence of venous thrombotic events was
16.6, 11.8 and 11.1 percent, respectively for the three groups of patients. Heterozygotes showed no
thrombotic event. The difference for proven homozygotes was statistically significant, while for the
other groups only a trend was present.
Conclusion:
proven homozygous or compound heterozygous patients with the Arg304Gln mutation
showed a higher than expected incidence of thrombotic events. The same is true for probable cases
gathered only on the basis of clotting tests. These patients, because of their frequent lack of bleeding
and for their relatively high prevalence of thrombosis should probably receive only limited replacement
therapy in case of surgical procedures.