Who are at risk for thromboembolism after arthroplasty? A systematic review and meta-analysis.
BACKGROUND
Thromboembolism, including deep venous thrombosis and pulmonary embolism, is a grave threat to patients undergoing total joint replacement. Using a systematic review and meta-analysis we asked whether gene mutations or polymorphisms could be risk factors for thrombosis after arthroplasty.


METHODS
We performed a comprehensive search of Medline, PubMed, Embase, Cochrane databases, China National Knowledge Infrastructure (CNKI), and Google Scholar, and identified 19 studies detailing genetic investigations of patients with thromboembolism following joint replacement.


RESULTS
Our meta-analyses included 5149 patients who underwent arthroplasty surgery. Significant associations with venous thromboembolism were identified for factor G1691A (odds ratio (OR) 1.41, 95% confidence interval (CI) 1.03 - 1.94, p=0.03), prothrombin G20210A (OR 2.16, 95% CI, 1.27- 3.69, p=0.005), and MTHFR/C677T/TT (OR 2.36, 95% CI 1.03 - 5.42, p=0.04) in Caucasian populations. No significant gene mutation was identified in Asian populations.


CONCLUSIONS
This study suggests a way to identify patients scheduled for arthroplasty who are at higher risk of thrombosis, enabling individualized treatment.
Department of Orthopedics Surgery, The Second Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, China.
Xindie
X
Zhou
Wenkang
W
Qian
Jin
J
Li
Pengli
P
Zhang
Zhigao
Z
Yang
Weiping
W
Chen
Lidong
L
Wu
D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D005165:Factor V / Q000235:genetics; D006801:Humans; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D011110:Polymorphism, Genetic; D011516:Prothrombin / Q000235:genetics; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology* / Q000235:genetics*
C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin; C573423:MTHFR protein, human; D042965:Methylenetetrahydrofolate Reductase (NADPH2)
ACE; APC; Arthroplasty; CI; DVT; FLV; Gene; Genetic Susceptibility; I/D; MTHFR; Meta-analysis; OR; PAI-1; PE; Polymorphism; STREGA; STROBE; THA; TKA; Thromboembolism; VTE; activated protein C; confidence interval; deep venous thrombosis; encoding angiotensin-converting enzyme; factor V Leiden; insertion/deletion; methylenetetrahydrofolate Reductase; odds ratio; plasminogen-activator inhibitor 1; pulmonary embolism; strengthening the Reporting of Genetic Association Studies; strengthening the Reporting of Observational Studies in Epidemiology; total hip arthroplasty; total knee arthroplasty; venous thrombus embolism