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'''Prothrombin G20210A''' (also the '''prothrombin 20210 mutation''', the '''factor II mutation''', or the '''prothrombin mutation''') is a [[Single-nucleotide polymorphism|genetic variant]] that approximately doubles or triples the risk of forming blood clots in the [[vein]]s.{{what?}}<!--MUST STE WHETHER REFERENCE IS TO HETEROZYGOUS OR HOMOZYGOUS CASES, AND WHETHER REFERENCE IS TO MONO- VS. COMPOUND CASES OF MUTATION--> The variant is commonly associated with the disease [[venous thromboembolism]] (VTE), which includes both [[deep vein thrombosis]] and [[pulmonary embolism]]. Most carriers, though, never develop VTE in their lifetime.<ref name=RosendaalReitsma/>
'''Prothrombin G20210A''' refers to a human [[Single-nucleotide polymorphism|gene mutation]] that, alongside other [[Coagulation#The_coagulation_cascade|blood clotting (fibrinogen) pathway]] mutations (e.g., such as [[Factor V Leiden]]), increases the risk of [[thrombophilia]], a condition resulting in the formation of deleterious blood clots in the [[vein]]s of the body.<!--DOUBLES, TRIPLES VERBIAGE NOT IN MAIN BODY, SO UNSOURCED, AND TOO VAGUE TO BE MEANINGFUL. PRECISE RISK RATIOS DEMAND STATING HETEROZYGOUS/HOMOZYGOUS, AND RELATION TO OTHER MUTATIONS.--> The "G20210A" refers to the fact that the mutation is a [[guanine]] (G) to [[adenine]] (A) substitution at position 20210 of the [[DNA]] of the [[prothrombin]] gene. Because [[prothrombin]] is also known as [[factor II]], the mutation is also sometimes referred to as the '''factor II mutation''' or simply the '''prothrombin mutation'''; in either case, the names may appear with or without the accompanying G20210A location specifier (unhelpfully, since prothrombin mutations other than G20210A are known). This mutation (or more accurately, [[single-nucleotide polymorphism]] or variant), is commonly associated with increased risk of occurence and recurrence of the disease [[venous thromboembolism]] (VTE), including both [[deep vein thrombosis]] (DVT) and [[pulmonary embolism]] (PE). As of 2005, it was believed that most carriers of the mutation never develop VTE in their lifetimes.<ref name=RosendaalReitsma/>{{update after}}


==Background==
Prothrombin G20210A was identified in the 1990s, is almost exclusively present in [[Caucasian race|Caucasian]]s,<ref name="RosendaalReitsma" /> and is estimated to have originated in that population slightly over 20,000 years ago.<ref>[http://omim.org/entry/176930#0009 Coagulation factor II; F2: .0009 thrombosis, susceptibility to] OMIM. Accessed January 23, 2012.</ref> About 2 to 3% of Caucasians carry the variant,<ref name="Rosendaal2005" /> and it confers a 2- to 3-fold higher risk of VTE. Deficiencies in the anticoagulants [[Protein C]] and [[Protein S]] give a higher risk (5- to 10-fold).<ref name="RosendaalReitsma">{{cite journal |author=Rosendaal FR, Reitsma PH|title=Genetics of VT|journal=J. Thromb. Haemost.|volume=7 Suppl 1|issue=|pages=301–4|date=July 2009|pmid=19630821|doi=10.1111/j.1538-7836.2009.03394.x|url=http://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2009.03394.x/full}}</ref> Behind non-O [[blood type]]<ref name="ReitsmaMV">{{cite journal|author=Reitsma PH, Versteeg HH, Middeldorp S|title=Mechanistic view of risk factors for venous thromboembolism|journal=Arterioscler Thromb Vasc Biol|year=2012|volume=32|issue=3|pages=563–8|pmid=22345594|doi=10.1161/ATVBAHA.111.242818}}</ref> and [[factor V Leiden]], prothrombin G20210A is one of the most common genetic risk factors for VTE.<ref name="Basic patho">{{cite journal|author=Martinelli I, Bucciarelli P, Mannucci PM|title=Thrombotic risk factors: basic pathophysiology|journal=Crit Care Med|year=2010|volume=38|issue=2 Suppl|pages=S3-9|pmid=20083911|doi=10.1097/CCM.0b013e3181c9cbd9}}</ref> It was realized in 1996 that a particular change in the genetic code produces the body to make too much of the prothrombin protein. By having too much prothrombin, it increases the chances the blood clotting. Individuals who carry the condition have the prothrombin mutation which can be inherited by offspring.<ref name=":0">{{Cite journal|last=Varga|first=E. A.|date=2004|title=Prothrombin 20210 mutation|url=http://circ.ahajournals.org/content/110/3/e15.full#T1|journal=Circulation|doi=10.1161/01.CIR.0000135582.53444.87}}</ref>
Prothrombin G20210A was identified in the 1990s, is almost exclusively present in [[Caucasian race|Caucasian]]s,<ref name="RosendaalReitsma" /> and is estimated to have originated in that population slightly over 20,000 years ago.<ref>Kniffin, Cassandra L. & McKusick, Victor A. (2012-06-20). [http://omim.org/entry/176930#0009 Coagulation factor II; F2: .0009 thrombosis, susceptibility to] OMIM. Accessed January 23, 2012.{{better source}}</ref>{{better source}} About 2 to 3% of Caucasians carry the variant,<ref name="Rosendaal2005" /> and it confers a 2- to 3-fold higher risk of VTE. Deficiencies in the anticoagulants [[Protein C]] and [[Protein S]] give a higher risk (5- to 10-fold).<ref name="RosendaalReitsma">{{cite journal |author=Rosendaal FR, Reitsma PH|title=Genetics of VT|journal=J. Thromb. Haemost.|volume=7 Suppl 1|issue=|pages=301–4|date=July 2009|pmid=19630821|doi=10.1111/j.1538-7836.2009.03394.x|url=http://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2009.03394.x/full}}</ref> Behind non-O [[blood type]]<ref name="ReitsmaMV">{{cite journal|author=Reitsma PH, Versteeg HH, Middeldorp S|title=Mechanistic view of risk factors for venous thromboembolism|journal=Arterioscler Thromb Vasc Biol|year=2012|volume=32|issue=3|pages=563–8|pmid=22345594|doi=10.1161/ATVBAHA.111.242818}}</ref> and [[factor V Leiden]], prothrombin G20210A is one of the most common genetic risk factors for VTE.<ref name="Basic patho">{{cite journal|author=Martinelli I, Bucciarelli P, Mannucci PM|title=Thrombotic risk factors: basic pathophysiology|journal=Crit Care Med|year=2010|volume=38|issue=2 Suppl|pages=S3-9|pmid=20083911|doi=10.1097/CCM.0b013e3181c9cbd9}}</ref> It was realized in 1996 that a particular change in the genetic code produces the body to make too much of the prothrombin protein. By having too much prothrombin, it increases the chances the blood clotting. Individuals who carry the condition have the prothrombin mutation which can be inherited by offspring.<ref name=":0">{{Cite journal|last=Varga|first=E. A.|date=2004|title=Prothrombin 20210 mutation|url=http://circ.ahajournals.org/content/110/3/e15.full#T1|journal=Circulation|doi=10.1161/01.CIR.0000135582.53444.87}}</ref>


The polymorphism is located in a [[noncoding DNA|noncoding]] region of the [[prothrombin]] gene ([[3' untranslated region]] nucleotide 20210{{efn|Specifically, position 20210 refers to the nucleotide on the [[sense strand]] downstream from the DNA that codes for the [[start codon]] (ATG, positions 1 to 3).<ref name="Degen">{{cite journal| author=Degen SJ, Davie EW| title=Nucleotide sequence of the gene for human prothrombin | journal=Biochemistry | year= 1987 | volume= 26 | issue= 19 | pages= 6165–77 | pmid=2825773 | doi=10.1021/bi00393a033 }}</ref>}}), replacing [[guanine]] with [[adenine]].<ref name="Basic patho" /><ref name="Poort">{{cite journal|author=Poort SR, Rosendaal FR, Reitsma PH, Bertina RM|title=A common genetic variation in the 3'-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis|journal=Blood|year=1996|volume=88|issue=10|pages=3698–703|pmid=8916933|url=http://bloodjournal.hematologylibrary.org/content/88/10/3698.long}}</ref> The position is at or near where the pre-mRNA will have the [[poly-A tail]] attached.<ref name="Poort" /> The variant causes elevated plasma [[prothrombin]] levels ([[hyperprothrombinemia]]),<ref name="Basic patho" /> possibly due to increased pre-mRNA stability.<ref name="Poort" /> Prothrombin is the precursor to [[thrombin]], which plays a key role in causing blood to clot ([[blood coagulation]]). G20210A can thus contribute to a state of [[hypercoagulability]], but not particularly with [[arterial thrombosis]].<ref name="Basic patho" /> A 2006 [[meta-analysis]] showed only a 1.3-fold increased risk for [[coronary disease]].<ref name="Ye">{{cite journal |vauthors=Ye Z, Liu EH, Higgins JP, Keavney BD, Lowe GD, Collins R, etal|title=Seven haemostatic gene polymorphisms in coronary disease: meta-analysis of 66,155 cases and 91,307 controls|journal=Lancet|year=2006|volume=367|issue=9511|pages=651–8|pmid=16503463|doi=10.1016/S0140-6736(06)68263-9}}</ref>
The polymorphism is located in a [[noncoding DNA|noncoding]] region of the [[prothrombin]] gene ([[3' untranslated region]] nucleotide 20210{{efn|Specifically, position 20210 refers to the nucleotide on the [[sense strand]] downstream from the DNA that codes for the [[start codon]] (ATG, positions 1 to 3).<ref name="Degen">{{cite journal| author=Degen SJ, Davie EW| title=Nucleotide sequence of the gene for human prothrombin | journal=Biochemistry | year= 1987 | volume= 26 | issue= 19 | pages= 6165–77 | pmid=2825773 | doi=10.1021/bi00393a033 }}</ref>}}), replacing [[guanine]] with [[adenine]].<ref name="Basic patho" /><ref name="Poort">{{cite journal|author=Poort SR, Rosendaal FR, Reitsma PH, Bertina RM|title=A common genetic variation in the 3'-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis|journal=Blood|year=1996|volume=88|issue=10|pages=3698–703|pmid=8916933|url=http://bloodjournal.hematologylibrary.org/content/88/10/3698.long}}</ref> The position is at or near where the pre-mRNA will have the [[poly-A tail]] attached.<ref name="Poort" /> The variant causes elevated plasma [[prothrombin]] levels ([[hyperprothrombinemia]]),<ref name="Basic patho" /> possibly due to increased pre-mRNA stability.<ref name="Poort" /> Prothrombin is the precursor to [[thrombin]], which plays a key role in causing blood to clot ([[blood coagulation]]). G20210A can thus contribute to a state of [[hypercoagulability]], but not particularly with [[arterial thrombosis]].<ref name="Basic patho" /> A 2006 [[meta-analysis]] showed only a 1.3-fold increased risk for [[coronary disease]].<ref name="Ye">{{cite journal |vauthors=Ye Z, Liu EH, Higgins JP, Keavney BD, Lowe GD, Collins R, etal|title=Seven haemostatic gene polymorphisms in coronary disease: meta-analysis of 66,155 cases and 91,307 controls|journal=Lancet|year=2006|volume=367|issue=9511|pages=651–8|pmid=16503463|doi=10.1016/S0140-6736(06)68263-9}}</ref>


== Risk factors ==
== Risk factors ==
{{refimprove section}}
Having the prothrombin mutation increases the risk of developing a DVT (Deep vein thrombosis), known as a blood clot in the deep veins, typically the legs. DVTs are threatening as they can damage the veins throughout the body, causing pain and swelling, and sometimes leading to disability. <ref name=":0" />
Having the prothrombin mutation increases the risk of developing a DVT (Deep vein thrombosis), known as a blood clot in the deep veins, often but not always in the legs.{{cn}} DVTs are threatening as they can damage the veins throughout the body, causing pain and swelling, and sometimes leading to disability.{{cn}}
[[File:Deep Vein Thrombosis of the leg. .jpg|thumb|<ref>{{Cite journal|date=2016-04-03|title=Thrombophilia|url=https://en.wikipedia.org/w/index.php?title=Thrombophilia&oldid=713362096|journal=Wikipedia, the free encyclopedia|language=en}}</ref>Deep vein thrombosis (to the left in the image) located on the right leg. The leg has gained is swelling and redness due to venous outflow obstruction, caused by the haematological disorder.]]
<ref>{{Cite journal|date=2016-04-03|title=Thrombophilia|url=https://en.wikipedia.org/w/index.php?title=Thrombophilia&oldid=713362096|journal=Wikipedia, the free encyclopedia|language=en}}</ref>


Most variety of people who have this prothrombin gene mutation do not require any treatment but need to be cautious throughout periods when the possibility of getting a blood clot may be enlarged (e.g. after surgery, during long flights etc). Occasionally people with the mutation may need to go on blood thinning medication to decrease the risk of developing blood clots.<ref>{{Cite web|url=http://www.melbournehaematology.com.au/fact-sheets/prothrombin-gene-mutation.html|title=Prothrombin Gene Mutation {{!}} Fact Sheets|last=Haematology|first=Melbourne|website=www.melbournehaematology.com.au|access-date=2016-05-06}}{{better source}}</ref>{{better source}} As there is no cure for the mutation, studies throughout the world are becoming conversant, emitting various medications in order to decrease risk factors.
Most variety of people who have this prothrombin gene mutation do not require any treatment but need to be cautious throughout periods when the possibility of getting a blood clot may be enlarged (e.g. after surgery, during long flights etc); occasionally people with the mutation may need to go on blood thinning medication to decrease the risk of developing blood clots.<ref>{{Cite web|url=http://www.melbournehaematology.com.au/fact-sheets/prothrombin-gene-mutation.html|title=Prothrombin Gene Mutation {{!}} Fact Sheets|last=Haematology|first=Melbourne|website=www.melbournehaematology.com.au|access-date=2016-05-06}}{{better source}}</ref>{{better source}} As there is no cure for the mutation, studies throughout the world are becoming conversant, emitting various medications in order to decrease risk factors.


Heterozygous carriers who take [[Oral_contraceptives]] are at a 15-fold increased risk of VTE,<ref name="Rosendaal2005">{{cite journal |author=Rosendaal FR|title=Venous thrombosis: the role of genes, environment, and behavior|journal=Hematology Am. Soc. Hematol. Educ. Program|volume=2005|issue=1|pages=1–12|year=2005|pmid=16304352|doi=10.1182/asheducation-2005.1.1|url=http://asheducationbook.hematologylibrary.org/cgi/content/full/2005/1/1}}</ref> while carriers also [[Heterozygous]] with factor V Leiden have an approximate 20-fold higher risk.<ref name="RosendaalReitsma" /> In a recommendation statement on VTE, [[genetic testing]] for G20210A in adults that developed unprovoked VTE{{efn|Provoked VTE is triggered by situations such as surgery, trauma, cancer, or immobility.}} was disadvised, as was testing in asymptomatic family members related to G20210A carriers who developed VTE.<ref name="EGAPP">{{cite journal|author=Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group|title=Recommendations from the EGAPP Working Group: routine testing for Factor V Leiden (R506Q) and prothrombin (20210G>A) mutations in adults with a history of idiopathic venous thromboembolism and their adult family members|journal=Genet Med|year=2011|volume=13|issue=1|pages=67–76|pmid=21150787|doi=10.1097/GIM.0b013e3181fbe46f|url=http://journals.lww.com/geneticsinmedicine/Fulltext/2011/01000/Recommendations_from_the_EGAPP_Working_Group_.11.aspx}}</ref> In those who develop VTE, the results of thrombophilia tests (wherein the variant can be detected) rarely play a role in the length of treatment.<ref name="Baglin">{{cite journal|author=Baglin T|title=Inherited and acquired risk factors for venous thromboembolism|journal=Semin Respir Crit Care Med|year=2012|volume=33|issue=2|pages=127–37|pmid=22648484|doi=10.1055/s-0032-1311791}}</ref>
Heterozygous carriers who take [[Oral_contraceptives]] are at a 15-fold increased risk of VTE,<ref name="Rosendaal2005">{{cite journal |author=Rosendaal FR|title=Venous thrombosis: the role of genes, environment, and behavior|journal=Hematology Am. Soc. Hematol. Educ. Program|volume=2005|issue=1|pages=1–12|year=2005|pmid=16304352|doi=10.1182/asheducation-2005.1.1|url=http://asheducationbook.hematologylibrary.org/cgi/content/full/2005/1/1}}</ref> while carriers also [[Heterozygous]] with factor V Leiden have an approximate 20-fold higher risk.<ref name="RosendaalReitsma" /> In a recommendation statement on VTE, [[genetic testing]] for G20210A in adults that developed unprovoked VTE{{efn|Provoked VTE is triggered by situations such as surgery, trauma, cancer, or immobility.}} was disadvised, as was testing in asymptomatic family members related to G20210A carriers who developed VTE.<ref name="EGAPP">{{cite journal|author=Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group|title=Recommendations from the EGAPP Working Group: routine testing for Factor V Leiden (R506Q) and prothrombin (20210G>A) mutations in adults with a history of idiopathic venous thromboembolism and their adult family members|journal=Genet Med|year=2011|volume=13|issue=1|pages=67–76|pmid=21150787|doi=10.1097/GIM.0b013e3181fbe46f|url=http://journals.lww.com/geneticsinmedicine/Fulltext/2011/01000/Recommendations_from_the_EGAPP_Working_Group_.11.aspx}}</ref> In those who develop VTE, the results of thrombophilia tests (wherein the variant can be detected) rarely play a role in the length of treatment.<ref name="Baglin">{{cite journal|author=Baglin T|title=Inherited and acquired risk factors for venous thromboembolism|journal=Semin Respir Crit Care Med|year=2012|volume=33|issue=2|pages=127–37|pmid=22648484|doi=10.1055/s-0032-1311791}}</ref>

Revision as of 23:32, 19 May 2016

Prothrombin G20210A

Prothrombin G20210A refers to a human gene mutation that, alongside other blood clotting (fibrinogen) pathway mutations (e.g., such as Factor V Leiden), increases the risk of thrombophilia, a condition resulting in the formation of deleterious blood clots in the veins of the body. The "G20210A" refers to the fact that the mutation is a guanine (G) to adenine (A) substitution at position 20210 of the DNA of the prothrombin gene. Because prothrombin is also known as factor II, the mutation is also sometimes referred to as the factor II mutation or simply the prothrombin mutation; in either case, the names may appear with or without the accompanying G20210A location specifier (unhelpfully, since prothrombin mutations other than G20210A are known). This mutation (or more accurately, single-nucleotide polymorphism or variant), is commonly associated with increased risk of occurence and recurrence of the disease venous thromboembolism (VTE), including both deep vein thrombosis (DVT) and pulmonary embolism (PE). As of 2005, it was believed that most carriers of the mutation never develop VTE in their lifetimes.[1][needs update]

Background

Prothrombin G20210A was identified in the 1990s, is almost exclusively present in Caucasians,[1] and is estimated to have originated in that population slightly over 20,000 years ago.[2][better source needed] About 2 to 3% of Caucasians carry the variant,[3] and it confers a 2- to 3-fold higher risk of VTE. Deficiencies in the anticoagulants Protein C and Protein S give a higher risk (5- to 10-fold).[1] Behind non-O blood type[4] and factor V Leiden, prothrombin G20210A is one of the most common genetic risk factors for VTE.[5] It was realized in 1996 that a particular change in the genetic code produces the body to make too much of the prothrombin protein. By having too much prothrombin, it increases the chances the blood clotting. Individuals who carry the condition have the prothrombin mutation which can be inherited by offspring.[6]

The polymorphism is located in a noncoding region of the prothrombin gene (3' untranslated region nucleotide 20210[a]), replacing guanine with adenine.[5][8] The position is at or near where the pre-mRNA will have the poly-A tail attached.[8] The variant causes elevated plasma prothrombin levels (hyperprothrombinemia),[5] possibly due to increased pre-mRNA stability.[8] Prothrombin is the precursor to thrombin, which plays a key role in causing blood to clot (blood coagulation). G20210A can thus contribute to a state of hypercoagulability, but not particularly with arterial thrombosis.[5] A 2006 meta-analysis showed only a 1.3-fold increased risk for coronary disease.[9]

Risk factors

Having the prothrombin mutation increases the risk of developing a DVT (Deep vein thrombosis), known as a blood clot in the deep veins, often but not always in the legs.[citation needed] DVTs are threatening as they can damage the veins throughout the body, causing pain and swelling, and sometimes leading to disability.[citation needed]

Most variety of people who have this prothrombin gene mutation do not require any treatment but need to be cautious throughout periods when the possibility of getting a blood clot may be enlarged (e.g. after surgery, during long flights etc); occasionally people with the mutation may need to go on blood thinning medication to decrease the risk of developing blood clots.[10][better source needed] As there is no cure for the mutation, studies throughout the world are becoming conversant, emitting various medications in order to decrease risk factors.

Heterozygous carriers who take Oral_contraceptives are at a 15-fold increased risk of VTE,[3] while carriers also Heterozygous with factor V Leiden have an approximate 20-fold higher risk.[1] In a recommendation statement on VTE, genetic testing for G20210A in adults that developed unprovoked VTE[b] was disadvised, as was testing in asymptomatic family members related to G20210A carriers who developed VTE.[11] In those who develop VTE, the results of thrombophilia tests (wherein the variant can be detected) rarely play a role in the length of treatment.[12]

Notes

  1. ^ Specifically, position 20210 refers to the nucleotide on the sense strand downstream from the DNA that codes for the start codon (ATG, positions 1 to 3).[7]
  2. ^ Provoked VTE is triggered by situations such as surgery, trauma, cancer, or immobility.

References

  1. ^ a b c d Rosendaal FR, Reitsma PH (July 2009). "Genetics of VT". J. Thromb. Haemost. 7 Suppl 1: 301–4. doi:10.1111/j.1538-7836.2009.03394.x. PMID 19630821.
  2. ^ Kniffin, Cassandra L. & McKusick, Victor A. (2012-06-20). Coagulation factor II; F2: .0009 thrombosis, susceptibility to OMIM. Accessed January 23, 2012.[better source needed]
  3. ^ a b Rosendaal FR (2005). "Venous thrombosis: the role of genes, environment, and behavior". Hematology Am. Soc. Hematol. Educ. Program. 2005 (1): 1–12. doi:10.1182/asheducation-2005.1.1. PMID 16304352.
  4. ^ Reitsma PH, Versteeg HH, Middeldorp S (2012). "Mechanistic view of risk factors for venous thromboembolism". Arterioscler Thromb Vasc Biol. 32 (3): 563–8. doi:10.1161/ATVBAHA.111.242818. PMID 22345594.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ^ a b c d Martinelli I, Bucciarelli P, Mannucci PM (2010). "Thrombotic risk factors: basic pathophysiology". Crit Care Med. 38 (2 Suppl): S3-9. doi:10.1097/CCM.0b013e3181c9cbd9. PMID 20083911.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ^ Varga, E. A. (2004). "Prothrombin 20210 mutation". Circulation. doi:10.1161/01.CIR.0000135582.53444.87.
  7. ^ Degen SJ, Davie EW (1987). "Nucleotide sequence of the gene for human prothrombin". Biochemistry. 26 (19): 6165–77. doi:10.1021/bi00393a033. PMID 2825773.
  8. ^ a b c Poort SR, Rosendaal FR, Reitsma PH, Bertina RM (1996). "A common genetic variation in the 3'-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis". Blood. 88 (10): 3698–703. PMID 8916933.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ^ Ye Z, Liu EH, Higgins JP, Keavney BD, Lowe GD, Collins R, et al. (2006). "Seven haemostatic gene polymorphisms in coronary disease: meta-analysis of 66,155 cases and 91,307 controls". Lancet. 367 (9511): 651–8. doi:10.1016/S0140-6736(06)68263-9. PMID 16503463.
  10. ^ Haematology, Melbourne. "Prothrombin Gene Mutation | Fact Sheets". www.melbournehaematology.com.au. Retrieved 2016-05-06.[better source needed]
  11. ^ Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group (2011). "Recommendations from the EGAPP Working Group: routine testing for Factor V Leiden (R506Q) and prothrombin (20210G>A) mutations in adults with a history of idiopathic venous thromboembolism and their adult family members". Genet Med. 13 (1): 67–76. doi:10.1097/GIM.0b013e3181fbe46f. PMID 21150787.
  12. ^ Baglin T (2012). "Inherited and acquired risk factors for venous thromboembolism". Semin Respir Crit Care Med. 33 (2): 127–37. doi:10.1055/s-0032-1311791. PMID 22648484.
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