The effect of the plasminogen activator inhibitor-1 4G/5G polymorphism on the Venous thromboembolism risk after total knee arthroplasty

Abstract

Abstract Background We herein determine the relationship between 4G/5G polymorphism of the plasminogen activator inhibitor-1 (PAI-1) gene and Venous thromboembolism (VTE) after total knee arthroplasty (TKA); and identify independent risk factors associated with deep vein thrombosis (DVT) after TKA through multivariate regression analysis. Methods From August of 2022 to November of 2022, 100 participants who underwent primary knee arthroplasty were enrolled in the study. Venous whole blood samples were collected to determine PAI-1 4G/5G genotypes. Lower extremity venous ultrasound was performed to detect DVT on the 5th day postoperatively or when patients had symptoms of DVT. Univariate analyses were performed using the chi-square test. Variables with a P value of less than 0.10 on univariate analysis were entered into multivariate analysis. reported risk factors (Sex, age, operating time, disease, hemostatic drugs, laterality, D-dimer, anticoagulants) for DVT after knee arthroplasty, although the difference was not significant in our study, were also entered into multivariate analysis. Multivariate analysis was performed using a logistic proportional hazards regression model. Results The incidence of DVT in this study was 52%. There was no significant difference in gender proportion between the DVT group and the non-DVT group. The DVT group had reduced intraoperative blood loss (98.0 ml) than the non-DVT group (134.2 ml), although the difference was not statistically significant. The value of D-dimer in DVT group (0.27) was lower than that in the non-DVT group (0.69), but the difference was not significant. On univariate analysis, the 4G/5G genotype of PAI-1 gene was more represented in DVT group, as compared to the non- DVT group. Sex, age, operating time, disease, hemostatic drugs, laterality, D-dimer, anticoagulants have also been considered predictors of DVT in many studies; therefore, we also included these items in our multivariate analysis. On multivariate analysis, the 4G/5G genotype of PAI-1 gene was identified as independent prognostic factors for DVT after TKA. Conclusions When anticoagulants were used after total knee arthroplasty, the incidence of deep vein thrombosis was 52%. The 4G/5G genotype of PAI-1 gene may be a high-risk factor for DVT in patients undergoing TKA.