Table 3.

The double-edged sword of thrombophilia: evolutionary disadvantages and advantages of factor V Leiden

	Estimated incidence*	Probable trend in incidence since premodern times	Relevant to chances of offspring†
Hemostasis
Disadvantages
Venous thromboembolism	Common	Increased	Yes
Acute myocardial infarction	Common	Increased	Yes
Ischemic colitis	Uncommon	Increased	No
Ischemic stroke in children	Rare	—	Yes
Legg-Calvé-Perthes disease	Rare	—	Yes
Advantages
Excessive intrapartum blood loss	Common	Decreased	Yes
Lower menstrual blood loss	Common	Decreased	Yes
Reduced blood loss	Common	Decreased	Yes
Spontaneous intracranial hemorrhage	Uncommon	Increased	No
Hemorrhagic disease of the newborn	Uncommon	Decreased	Yes
Milder hemophilia phenotype	Rare	Stable	Yes
Inflammation
Disadvantages
Procoagulant state in sepsis	Common	Decreased	Yes
Mortality severe sepsis	Common	Decreased	Yes
Purpura fulminans	Rare	Decreased	Yes
Advantages
Survival severe sepsis	Common	Decreased	Yes
Susceptibility severe sepsis	Common	Decreased	Yes
ARDS mortality	Uncommon	Decreased	Yes
Protection from diabetic nephropathy	Common	Increased	Yes
Fertility
Disadvantages
Placental abruption	Common	—	Yes
Pre-eclampsia	Common	—	Yes
Intra-uterine growth restriction	Common	—	Yes
Early pregnancy loss (<24 wk)	Common	—	Yes
Late pregnancy loss (≥24 wk)	Common	—	Yes
Advantages
Fecundity females	—	—	Yes
In vitro fertilization success	—	—	Yes
Fecundity males	—	—	Yes
Sperm count	—	—	Yes

Table adapted from a previous review.⁵⁴

^*Common: More than 5/10 000 cases per year in general population. Uncommon: 0.1 to 5 per 10 000. Rare: <0.1 per 10 000.

^†When present, does the disease or phenotype influence the chances of having fertile offspring, by affecting either the mortality at or before the fertile age, or the chances of successful mating?