Multiple gene interaction and modulation of hemostatic balance

Recent progress in the understanding of the pathophysiology of hemostasis has established that blood coagulation disorders causing bleeding or thrombosis often indicate a multi-casual nature in which the interaction between genetic and acquired factors plays a major mechanistic role. The interaction of two or more factors may attenuate clinical symptoms. However, a synergic worsening may also occur, resulting in a higher risk than expected from the combination of the separate effects. The role of genetic factors on the modulation of the phenotypic expression of coagulation disorders will be addressed in this review, with particular emphasis on the underlying pathogenic mechanisms and clinical implications.