Skip to main content
Top
Published in: Journal of Thrombosis and Thrombolysis 4/2020

Open Access 01-05-2020

Thrombophilia screening revisited: an issue of personalized medicine

Authors: Giuseppe Colucci, Dimitrios A. Tsakiris

Published in: Journal of Thrombosis and Thrombolysis | Issue 4/2020

Login to get access

Abstract

Clinical thrombophilia is the consequence of multiple gene and/or environment interactions. Thrombophilia screening requires a targeted patient with specific indication, in which a finding would have implications. Carrying out a thrombophilia examination in the physician’s practice is often a cause of uncertainty and concern. The concerns begin in choosing the right patient to be examined, are associated with the time of investigation, with the choice of analysis, the test-material and with the correct interpretation of the results. Difficulties, which can influence the results, can occur with both organization and blood sampling. As common for any analysis, pre-analytical, analytical and post-analytical factors should be considered, as well as the possibility of false positive or false negative results. Finally, recommendation of correct therapeutic and prophylactic measures for the patient and his relatives is an additional focus. In this article we want to provide—on the basis of the evidence and personal experience—the theory of thrombophilia-investigation, the indications for testing, as well as practical recommendations for treatment options.
Literature
4.
go back to reference Stricker H, Colucci G, Godio M, Mossi G, Mombelli G (2003) The influence of a prolonged sitting position on the biochemical markers of coagulation activation in healthy subjects: evidence of reduced thrombin generation. J Thromb Haemost 1(2):380–381CrossRef Stricker H, Colucci G, Godio M, Mossi G, Mombelli G (2003) The influence of a prolonged sitting position on the biochemical markers of coagulation activation in healthy subjects: evidence of reduced thrombin generation. J Thromb Haemost 1(2):380–381CrossRef
11.
go back to reference Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, Forcier A, Dalen JE (1991) A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med 151(5):933–938CrossRef Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, Forcier A, Dalen JE (1991) A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med 151(5):933–938CrossRef
12.
go back to reference Rosendaal FR (1999) Venous thrombosis: a multicausal disease. Lancet 353(9159):1167–1173CrossRef Rosendaal FR (1999) Venous thrombosis: a multicausal disease. Lancet 353(9159):1167–1173CrossRef
14.
go back to reference Cohn DM, Middeldorp S (2008) Early termination of the multicentre randomised clinical trial to evaluate the benefit of testing for thrombophilia following a first venous thromboembolism: the NOSTRADAMUS study. Ned Tijdschr Geneeskd 152(38):2093–2094PubMed Cohn DM, Middeldorp S (2008) Early termination of the multicentre randomised clinical trial to evaluate the benefit of testing for thrombophilia following a first venous thromboembolism: the NOSTRADAMUS study. Ned Tijdschr Geneeskd 152(38):2093–2094PubMed
19.
go back to reference Pernod G, Biron-Andreani C, Morange PE, Boehlen F, Constans J, Couturaud F, Drouet L, Jude B, Lecompte T, Le Gal G, Trillot N, Wahl D, French group on h, thrombosis, French Society of vascular m (2009) Recommendations on testing for thrombophilia in venous thromboembolic disease: a French consensus guideline. J Mal Vasc 34(3):156–203. https://doi.org/10.1016/j.jmv.2009.02.005 CrossRefPubMed Pernod G, Biron-Andreani C, Morange PE, Boehlen F, Constans J, Couturaud F, Drouet L, Jude B, Lecompte T, Le Gal G, Trillot N, Wahl D, French group on h, thrombosis, French Society of vascular m (2009) Recommendations on testing for thrombophilia in venous thromboembolic disease: a French consensus guideline. J Mal Vasc 34(3):156–203. https://​doi.​org/​10.​1016/​j.​jmv.​2009.​02.​005 CrossRefPubMed
21.
go back to reference Egeberg O (1965) Inherited antithrombin deficiency causing thrombophilia. Thromb Diath Haemorrh 13:516–530PubMed Egeberg O (1965) Inherited antithrombin deficiency causing thrombophilia. Thromb Diath Haemorrh 13:516–530PubMed
22.
go back to reference Griffin JH, Evatt B, Zimmerman TS, Kleiss AJ, Wideman C (1981) Deficiency of protein C in congenital thrombotic disease. J Clin Invest 68(5):1370–1373CrossRef Griffin JH, Evatt B, Zimmerman TS, Kleiss AJ, Wideman C (1981) Deficiency of protein C in congenital thrombotic disease. J Clin Invest 68(5):1370–1373CrossRef
26.
go back to reference Poort SR, Rosendaal FR, Reitsma PH, Bertina RM (1996) A common genetic variation in the 3'-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis. Blood 88(10):3698–3703CrossRef Poort SR, Rosendaal FR, Reitsma PH, Bertina RM (1996) A common genetic variation in the 3'-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis. Blood 88(10):3698–3703CrossRef
32.
go back to reference Germain M, Chasman DI, de Haan H, Tang W, Lindstrom S, Weng LC, de Andrade M, de Visser MC, Wiggins KL, Suchon P, Saut N, Smadja DM, Le Gal G, van Hylckama VA, Di Narzo A, Hao K, Nelson CP, Rocanin-Arjo A, Folkersen L, Monajemi R, Rose LM, Brody JA, Slagboom E, Aissi D, Gagnon F, Deleuze JF, Deloukas P, Tzourio C, Dartigues JF, Berr C, Taylor KD, Civelek M, Eriksson P, Cardiogenics C, Psaty BM, Houwing-Duitermaat J, Goodall AH, Cambien F, Kraft P, Amouyel P, Samani NJ, Basu S, Ridker PM, Rosendaal FR, Kabrhel C, Folsom AR, Heit J, Reitsma PH, Tregouet DA, Smith NL, Morange PE (2015) Meta-analysis of 65,734 individuals identifies TSPAN15 and SLC44A2 as two susceptibility loci for venous thromboembolism. Am J Hum Genet 96(4):532–542. https://doi.org/10.1016/j.ajhg.2015.01.019 CrossRefPubMedPubMedCentral Germain M, Chasman DI, de Haan H, Tang W, Lindstrom S, Weng LC, de Andrade M, de Visser MC, Wiggins KL, Suchon P, Saut N, Smadja DM, Le Gal G, van Hylckama VA, Di Narzo A, Hao K, Nelson CP, Rocanin-Arjo A, Folkersen L, Monajemi R, Rose LM, Brody JA, Slagboom E, Aissi D, Gagnon F, Deleuze JF, Deloukas P, Tzourio C, Dartigues JF, Berr C, Taylor KD, Civelek M, Eriksson P, Cardiogenics C, Psaty BM, Houwing-Duitermaat J, Goodall AH, Cambien F, Kraft P, Amouyel P, Samani NJ, Basu S, Ridker PM, Rosendaal FR, Kabrhel C, Folsom AR, Heit J, Reitsma PH, Tregouet DA, Smith NL, Morange PE (2015) Meta-analysis of 65,734 individuals identifies TSPAN15 and SLC44A2 as two susceptibility loci for venous thromboembolism. Am J Hum Genet 96(4):532–542. https://​doi.​org/​10.​1016/​j.​ajhg.​2015.​01.​019 CrossRefPubMedPubMedCentral
34.
go back to reference Downes K, Megy K, Duarte D, Vries M, Gebhart J, Hofer S, Shamardina O, Deevi SVV, Stephens J, Mapeta R, Tuna S, Al Hasso N, Besser MW, Cooper N, Daugherty L, Gleadall N, Greene D, Haimel M, Martin H, Papadia S, Revel-Vilk S, Sivapalaratnam S, Symington E, Thomas W, Thys C, Tolios A, Penkett CJ, BioResource N, Ouwehand WH, Abbs S, Laffan MA, Turro E, Simeoni I, Mumford AD, Henskens YMC, Pabinger I, Gomez K, Freson K (2019) Diagnostic high-throughput sequencing of 2396 patients with bleeding, thrombotic, and platelet disorders. Blood 134(23):2082–2091. https://doi.org/10.1182/blood.2018891192 CrossRefPubMedPubMedCentral Downes K, Megy K, Duarte D, Vries M, Gebhart J, Hofer S, Shamardina O, Deevi SVV, Stephens J, Mapeta R, Tuna S, Al Hasso N, Besser MW, Cooper N, Daugherty L, Gleadall N, Greene D, Haimel M, Martin H, Papadia S, Revel-Vilk S, Sivapalaratnam S, Symington E, Thomas W, Thys C, Tolios A, Penkett CJ, BioResource N, Ouwehand WH, Abbs S, Laffan MA, Turro E, Simeoni I, Mumford AD, Henskens YMC, Pabinger I, Gomez K, Freson K (2019) Diagnostic high-throughput sequencing of 2396 patients with bleeding, thrombotic, and platelet disorders. Blood 134(23):2082–2091. https://​doi.​org/​10.​1182/​blood.​2018891192 CrossRefPubMedPubMedCentral
36.
go back to reference Rosendaal FR, Doggen CJ, Zivelin A, Arruda VR, Aiach M, Siscovick DS, Hillarp A, Watzke HH, Bernardi F, Cumming AM, Preston FE, Reitsma PH (1998) Geographic distribution of the 20210 G to A prothrombin variant. Thromb Haemost 79(4):706–708CrossRef Rosendaal FR, Doggen CJ, Zivelin A, Arruda VR, Aiach M, Siscovick DS, Hillarp A, Watzke HH, Bernardi F, Cumming AM, Preston FE, Reitsma PH (1998) Geographic distribution of the 20210 G to A prothrombin variant. Thromb Haemost 79(4):706–708CrossRef
41.
go back to reference Young G, Albisetti M, Bonduel M, Brandao L, Chan A, Friedrichs F, Goldenberg NA, Grabowski E, Heller C, Journeycake J, Kenet G, Krumpel A, Kurnik K, Lubetsky A, Male C, Manco-Johnson M, Mathew P, Monagle P, van Ommen H, Simioni P, Svirin P, Tormene D, Nowak-Gottl U (2008) Impact of inherited thrombophilia on venous thromboembolism in children: a systematic review and meta-analysis of observational studies. Circulation 118(13):1373–1382. https://doi.org/10.1161/CIRCULATIONAHA.108.789008 CrossRefPubMed Young G, Albisetti M, Bonduel M, Brandao L, Chan A, Friedrichs F, Goldenberg NA, Grabowski E, Heller C, Journeycake J, Kenet G, Krumpel A, Kurnik K, Lubetsky A, Male C, Manco-Johnson M, Mathew P, Monagle P, van Ommen H, Simioni P, Svirin P, Tormene D, Nowak-Gottl U (2008) Impact of inherited thrombophilia on venous thromboembolism in children: a systematic review and meta-analysis of observational studies. Circulation 118(13):1373–1382. https://​doi.​org/​10.​1161/​CIRCULATIONAHA.​108.​789008 CrossRefPubMed
45.
go back to reference Goldberg RJ, Seneff M, Gore JM, Anderson FA, Jr, Greene HL, Wheeler HB, Dalen JE (1987) Occult malignant neoplasm in patients with deep venous thrrombosis. Arch Intern Med 147(2):251–253CrossRef Goldberg RJ, Seneff M, Gore JM, Anderson FA, Jr, Greene HL, Wheeler HB, Dalen JE (1987) Occult malignant neoplasm in patients with deep venous thrrombosis. Arch Intern Med 147(2):251–253CrossRef
46.
go back to reference Prandoni P, Lensing AW, Buller HR, Cogo A, Prins MH, Cattelan AM, Cuppini S, Noventa F, ten Cate JW (1992) Deep-vein thrombosis and the incidence of subsequent symptomatic cancer. N Engl J Med 327(16):1128–1133CrossRef Prandoni P, Lensing AW, Buller HR, Cogo A, Prins MH, Cattelan AM, Cuppini S, Noventa F, ten Cate JW (1992) Deep-vein thrombosis and the incidence of subsequent symptomatic cancer. N Engl J Med 327(16):1128–1133CrossRef
48.
go back to reference Carrier M, Lazo-Langner A, Shivakumar S, Tagalakis V, Zarychanski R, Solymoss S, Routhier N, Douketis J, Danovitch K, Lee AY, Le Gal G, Wells PS, Corsi DJ, Ramsay T, Coyle D, Chagnon I, Kassam Z, Tao H, Rodger MA, Investigators S (2015) Screening for Occult cancer in unprovoked venous thromboembolism. N Engl J Med 373(8):697–704. https://doi.org/10.1056/NEJMoa15606623 CrossRefPubMed Carrier M, Lazo-Langner A, Shivakumar S, Tagalakis V, Zarychanski R, Solymoss S, Routhier N, Douketis J, Danovitch K, Lee AY, Le Gal G, Wells PS, Corsi DJ, Ramsay T, Coyle D, Chagnon I, Kassam Z, Tao H, Rodger MA, Investigators S (2015) Screening for Occult cancer in unprovoked venous thromboembolism. N Engl J Med 373(8):697–704. https://​doi.​org/​10.​1056/​NEJMoa15606623 CrossRefPubMed
51.
go back to reference Simone B, De Stefano V, Leoncini E, Zacho J, Martinelli I, Emmerich J, Rossi E, Folsom AR, Almawi WY, Scarabin PY, den Heijer M, Cushman M, Penco S, Vaya A, Angchaisuksiri P, Okumus G, Gemmati D, Cima S, Akar N, Oguzulgen KI, Ducros V, Lichy C, Fernandez-Miranda C, Szczeklik A, Nieto JA, Torres JD, Le Cam-Duchez V, Ivanov P, Cantu-Brito C, Shmeleva VM, Stegnar M, Ogunyemi D, Eid SS, Nicolotti N, De Feo E, Ricciardi W, Boccia S (2013) Risk of venous thromboembolism associated with single and combined effects of factor V Leiden, prothrombin 20210A and methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls. Eur J Epidemiol 28(8):621–647. https://doi.org/10.1007/s10654-013-9825-8 CrossRefPubMedPubMedCentral Simone B, De Stefano V, Leoncini E, Zacho J, Martinelli I, Emmerich J, Rossi E, Folsom AR, Almawi WY, Scarabin PY, den Heijer M, Cushman M, Penco S, Vaya A, Angchaisuksiri P, Okumus G, Gemmati D, Cima S, Akar N, Oguzulgen KI, Ducros V, Lichy C, Fernandez-Miranda C, Szczeklik A, Nieto JA, Torres JD, Le Cam-Duchez V, Ivanov P, Cantu-Brito C, Shmeleva VM, Stegnar M, Ogunyemi D, Eid SS, Nicolotti N, De Feo E, Ricciardi W, Boccia S (2013) Risk of venous thromboembolism associated with single and combined effects of factor V Leiden, prothrombin 20210A and methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls. Eur J Epidemiol 28(8):621–647. https://​doi.​org/​10.​1007/​s10654-013-9825-8 CrossRefPubMedPubMedCentral
55.
go back to reference Wu O, Robertson L, Twaddle S, Lowe GD, Clark P, Greaves M, Walker ID, Langhorne P, Brenkel I, Regan L, Greer I (2006) Screening for thrombophilia in high-risk situations: systematic review and cost-effectiveness analysis. The thrombosis: risk and economic assessment of thrombophilia screening (TREATS) study. Health Technol Assess 10(11):1–110. https://doi.org/10.3310/hta10110 CrossRefPubMed Wu O, Robertson L, Twaddle S, Lowe GD, Clark P, Greaves M, Walker ID, Langhorne P, Brenkel I, Regan L, Greer I (2006) Screening for thrombophilia in high-risk situations: systematic review and cost-effectiveness analysis. The thrombosis: risk and economic assessment of thrombophilia screening (TREATS) study. Health Technol Assess 10(11):1–110. https://​doi.​org/​10.​3310/​hta10110 CrossRefPubMed
60.
go back to reference Giovanni L, Maria LG, Mauro R, Carlotta M, Federica R, Fabrizio P, Sheba J, Giuseppe DP, Alessandro B, Elio C, Herbert V (2011) Thrombophilia and damage of kidney during pregnancy. J Prenat Med 5(4):78–82PubMedPubMedCentral Giovanni L, Maria LG, Mauro R, Carlotta M, Federica R, Fabrizio P, Sheba J, Giuseppe DP, Alessandro B, Elio C, Herbert V (2011) Thrombophilia and damage of kidney during pregnancy. J Prenat Med 5(4):78–82PubMedPubMedCentral
61.
go back to reference Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, Cuadrado MJ, Dorner T, Ferrer-Oliveras R, Hambly K, Khamashta MA, King J, Marchiori F, Meroni PL, Mosca M, Pengo V, Raio L, Ruiz-Irastorza G, Shoenfeld Y, Stojanovich L, Svenungsson E, Wahl D, Tincani A, Ward MM (2019) EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 78(10):1296–1304. https://doi.org/10.1136/annrheumdis-2019-215213 CrossRefPubMed Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, Cuadrado MJ, Dorner T, Ferrer-Oliveras R, Hambly K, Khamashta MA, King J, Marchiori F, Meroni PL, Mosca M, Pengo V, Raio L, Ruiz-Irastorza G, Shoenfeld Y, Stojanovich L, Svenungsson E, Wahl D, Tincani A, Ward MM (2019) EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 78(10):1296–1304. https://​doi.​org/​10.​1136/​annrheumdis-2019-215213 CrossRefPubMed
65.
go back to reference Prandoni P, Noventa F, Ghirarduzzi A, Pengo V, Bernardi E, Pesavento R, Iotti M, Tormene D, Simioni P, Pagnan A (2007) The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica 92(2):199–205. https://doi.org/10.3324/haematol.10516 CrossRefPubMed Prandoni P, Noventa F, Ghirarduzzi A, Pengo V, Bernardi E, Pesavento R, Iotti M, Tormene D, Simioni P, Pagnan A (2007) The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica 92(2):199–205. https://​doi.​org/​10.​3324/​haematol.​10516 CrossRefPubMed
71.
go back to reference De Stefano V, Simioni P, Rossi E, Tormene D, Za T, Pagnan A, Leone G (2006) The risk of recurrent venous thromboembolism in patients with inherited deficiency of natural anticoagulants antithrombin, protein C and protein S. Haematologica 91(5):695–698PubMed De Stefano V, Simioni P, Rossi E, Tormene D, Za T, Pagnan A, Leone G (2006) The risk of recurrent venous thromboembolism in patients with inherited deficiency of natural anticoagulants antithrombin, protein C and protein S. Haematologica 91(5):695–698PubMed
72.
75.
go back to reference Cosmi B, Legnani C, Tosetto A, Pengo V, Ghirarduzzi A, Testa S, Prisco D, Poli D, Tripodi A, Marongiu F, Palareti G, Investigators P (2010) Usefulness of repeated D-dimer testing after stopping anticoagulation for a first episode of unprovoked venous thromboembolism: the PROLONG II prospective study. Blood 115(3):481–488. https://doi.org/10.1182/blood-2009-08-237354 CrossRefPubMed Cosmi B, Legnani C, Tosetto A, Pengo V, Ghirarduzzi A, Testa S, Prisco D, Poli D, Tripodi A, Marongiu F, Palareti G, Investigators P (2010) Usefulness of repeated D-dimer testing after stopping anticoagulation for a first episode of unprovoked venous thromboembolism: the PROLONG II prospective study. Blood 115(3):481–488. https://​doi.​org/​10.​1182/​blood-2009-08-237354 CrossRefPubMed
76.
go back to reference Palareti G, Legnani C, Antonucci E, Cosmi B, Poli D, Testa S, Tosetto A, Ageno W, Falanga A, Ferrini PM, Pengo V, Prandoni P, Investigators D (2019) D-dimer testing, with gender-specific cutoff levels, is of value to assess the individual risk of venous thromboembolic recurrence in non-elderly patients of both genders: a post hoc analysis of the DULCIS study. Intern Emerg Med. https://doi.org/10.1007/s11739-019-02216-y CrossRefPubMed Palareti G, Legnani C, Antonucci E, Cosmi B, Poli D, Testa S, Tosetto A, Ageno W, Falanga A, Ferrini PM, Pengo V, Prandoni P, Investigators D (2019) D-dimer testing, with gender-specific cutoff levels, is of value to assess the individual risk of venous thromboembolic recurrence in non-elderly patients of both genders: a post hoc analysis of the DULCIS study. Intern Emerg Med. https://​doi.​org/​10.​1007/​s11739-019-02216-y CrossRefPubMed
79.
go back to reference Franco Moreno AI, Garcia Navarro MJ, Ortiz Sanchez J, Martin Diaz RM, Madronal Cerezo E, de Ancos Aracil CL, Cabello Clotet N, Perales Fraile I, Gimeno Garcia S, Montero Hernandez C, Zapatero Gaviria A, Ruiz Giardin JM (2016) A risk score for prediction of recurrence in patients with unprovoked venous thromboembolism (DAMOVES). Eur J Intern Med 29:59–64. https://doi.org/10.1016/j.ejim.2015.12.010 CrossRefPubMed Franco Moreno AI, Garcia Navarro MJ, Ortiz Sanchez J, Martin Diaz RM, Madronal Cerezo E, de Ancos Aracil CL, Cabello Clotet N, Perales Fraile I, Gimeno Garcia S, Montero Hernandez C, Zapatero Gaviria A, Ruiz Giardin JM (2016) A risk score for prediction of recurrence in patients with unprovoked venous thromboembolism (DAMOVES). Eur J Intern Med 29:59–64. https://​doi.​org/​10.​1016/​j.​ejim.​2015.​12.​010 CrossRefPubMed
82.
go back to reference Turnbull C, Scott RH, Thomas E, Jones L, Murugaesu N, Pretty FB, Halai D, Baple E, Craig C, Hamblin A, Henderson S, Patch C, O'Neill A, Devereau A, Smith K, Martin AR, Sosinsky A, McDonagh EM, Sultana R, Mueller M, Smedley D, Toms A, Dinh L, Fowler T, Bale M, Hubbard T, Rendon A, Hill S, Caulfield MJ, Genomes P (2018) The 100 000 genomes project: bringing whole genome sequencing to the NHS. BMJ 361:k1687. https://doi.org/10.1136/bmj.k1687 CrossRefPubMed Turnbull C, Scott RH, Thomas E, Jones L, Murugaesu N, Pretty FB, Halai D, Baple E, Craig C, Hamblin A, Henderson S, Patch C, O'Neill A, Devereau A, Smith K, Martin AR, Sosinsky A, McDonagh EM, Sultana R, Mueller M, Smedley D, Toms A, Dinh L, Fowler T, Bale M, Hubbard T, Rendon A, Hill S, Caulfield MJ, Genomes P (2018) The 100 000 genomes project: bringing whole genome sequencing to the NHS. BMJ 361:k1687. https://​doi.​org/​10.​1136/​bmj.​k1687 CrossRefPubMed
Metadata
Title
Thrombophilia screening revisited: an issue of personalized medicine
Authors
Giuseppe Colucci
Dimitrios A. Tsakiris
Publication date
01-05-2020
Publisher
Springer US
Published in
Journal of Thrombosis and Thrombolysis / Issue 4/2020
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-020-02090-y

Other articles of this Issue 4/2020

Journal of Thrombosis and Thrombolysis 4/2020 Go to the issue