Cross-Ancestry Investigation of Venous Thromboembolism Genomic Predictors

Venous thromboembolism (VTE) is a complex disease with environmental and genetic determinants. We present new cross-ancestry meta-analyzed genome-wide association study (GWAS) results from 30 studies, with replication of novel loci and their characterization through in silico genomic interrogations. In our initial genetic discovery effort that included 55,330 participants with VTE (47,822 European, 6,320 African, and 1,188 Hispanic ancestry), we identified 48 novel associations of which 34 replicated after correction for multiple testing. In our combined discovery-replication analysis (81,669 VTE participants) and ancestry-stratified meta-analyses (European, African and Hispanic), we identified another 44 novel associations, which are new candidate VTE-associated loci requiring replication. In total, across all GWAS meta-analyses, we identified 135 independent genomic loci significantly associated with VTE risk. We also identified 31 novel transcript associations in transcriptome-wide association studies and 8 novel candidate genes with protein QTL Mendelian randomization analyses. In silico interrogations of hemostasis and hematology traits and a large phenome-wide association analysis of the 135 novel GWAS loci provided insights to biological pathways contributing to VTE, indicating that some loci may contribute to VTE through well-characterized coagulation pathways while others provide new data on the role of hematology traits, particularly platelet function. Many of the replicated loci are outside of known or currently hypothesized pathways to thrombosis. In summary, these findings highlight new pathways to thrombosis and provide novel molecules that may be useful in the development of antithrombosis treatments with reduced risk of bleeds.