Real-world data on Factor V Leiden in Sweden: A nationwide family study

This is the first nationwide real-world register-based family study of factor V Leiden (FVL). To determine number of diagnosed patients with FVL in Sweden and the associated risk for venous thromboembolism (VTE). The Swedish Multi-Generation Register was linked to the Swedish National patient register for the period 1964-2018. Patients with FVL (FVL heterozygotes or homozygotes) were linked to family members. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for VTE were calculated for individuals with FVL compared with relatives without FVL. Thrombophilia was defined as antiphospholipid antibodies, FVL, prothrombin G20210A mutation, deficiencies of antithrombin, protein C, and protein S. Among 149,808 individuals from 9,641 pedigrees, 11,367 [66.4% females] family members were diagnosed with FVL corresponding to around 0.1% of the Swedish population. Totally 5,757 (59.7%) of the 9,641 index cases (first diagnosed FVL case in pedigree) suffered from VTE, A total of 17,703 (11.8%) family members were affected by VTE. The aHR for VTE for FVL carriers was 9.23 (95%CI 8.92-9.55). After exclusion of 9,641 index cases aHR for VTE was 6.74 (95%CI6.24-7.28). The risk of VTE was dependent on number of thrombophilias present in a patient even after exclusion of index cases. One thrombophilia was associated with an aHR of 7.79 (95%CI7.26-8.36), two thrombophilias 14.71 (95%CI11.10-19.50), and three or more thrombophilias 18.99 (95%CI6.13-58.87). This nationwide real-world register-based family study indicates that FVL is underdiagnosed in Sweden. FVL is a risk factor for VTE in thrombophilic families in Sweden. Thrombophilia screening appears worthwhile.