Hyperhomocysteinemia: no longer a consideration in the management of venous thromboembolism

To determine whether clinicians should continue to screen for or treat hyperhomocysteinemia among individuals with venous thromboembolism.

The present review addresses four questions: Is hyperhomocysteinemia a risk factor for venous thromboembolism? Are the genetic polymorphisms that cause hyperhomocysteinemia risk factors for venous thromboembolism? Does lowering plasma homocysteine alter the risk of venous thromboembolism? What should clinicians do?

There may be a modest association between mild-to-moderate hyperhomocysteinemia and venous thromboembolism risk. This may be partly explained by genetic polymorphisms that affect homocysteine metabolism. However, two randomized placebo-controlled trials have failed to show a significant reduction in the risk of venous thromboembolism by lowering plasma homocysteine.