Hematologic genetic testing in high-risk patients before knee arthroplasty: a pilot study

Area of Science:

• Thrombosis research
• Genetic predisposition
• Postoperative complications

Background:

• Patients with a personal or familial history of thromboembolism face elevated risks for DVT and PE post-knee arthroplasty.
• The underlying reasons for increased thrombosis risk despite similar procedures and prophylaxis remain unclear.
• Genetic predisposition is hypothesized as a significant contributing factor.

Purpose of the Study:

• To determine the frequency of 12 specific hemostatic and genetic factors in high-risk patients undergoing knee arthroplasty.
• To compare the prevalence of these factors in the high-risk cohort against the general population.

Main Methods:

• Preoperative hemostatic and genetic testing was performed on patients with a history of DVT/PE.
• Tests included antithrombin III activity, protein C/S activity, APC resistance, Factor V Leiden, prothrombin gene mutations, and phospholipid antibodies.
• Frequencies of abnormalities were compared to literature-reported population prevalence.

Main Results:

• Of 1944 patients, 43 had a history of DVT/PE.
• 16 of these 43 patients (37%) exhibited at least one abnormality.
• Eight patients (19%) had two or more prothrombotic abnormalities, with nine tests showing higher frequency than in the general population.

Conclusions:

• Individuals with a personal or familial history of DVT/PE demonstrate a high prevalence of hereditary prothrombotic abnormalities.
• Preoperative hematologist evaluation is recommended for these patients.
• Identifying these abnormalities can inform altered anticoagulation protocols and assess risks for other conditions.