[Potential mechanism of Peiyuan Fumai decoction() in regulating P-selectin/ P-selectin glycoprotein ligand-1 pathway for prevention and treatment of thrombosis after total knee arthroplasty].

Abstract

Objective: To explore effect of Peiyuan Fubai decoction ()on P-selectin/P-selectin glycoprotein ligand-1 (PSGL-1) pathway after total knee arthroplasty(TKA).

Methods: From May 2024 to April 2025, 68 patients who underwent TKA were selected and divided into combined group and western medicine group based on different treatment methods. There were 34 patients in western medicine group, including 7 males and 27 females;aged from 54 to 79 years old with an average of (67.44±5.34) years old;12 patients with grade Ⅲ and 22 patients with grade Ⅳ according to Kellgren-Lawrance(K-L) grade;oral rivaroxaban tablets were started 12 h after surgery and continued until 28 days after surgery. There were 34 patients in combined group, including 4 males and 30 females;aged from 59 to 83 years old with an average of (68.32±5.51) years old;10 patients with grade Ⅲ and 24 patients with grade Ⅳ according to K-L grade; Peiyuan Fubai decoction ()was orally administered starting from the first day until 28 days after surgery on the basis of western medicine group. The knee joint function was evaluated by visual analogue scale (VAS) and Hospital for Special Surgery (HSS) score before operation and 3, 7, 14, and 42 days after operation;the changes in hemoglobin (Hb), platelet count (PLT), activated partial thromboplastin time (APTT), and prothrombin time (PT) were compared between two groups;the expressions of P-selectin, PSGL-1, histone H3 citrullination (H3Cit), and von Willebrand factor (vWF) in plasma between two groups were compared before operation, 1 and 7 days after operation, and postoperative complications were recorded and compared.

Results: Both groups were followed up for 6 weeks. At 7 days after operation, VAS and HSS scores of combined group were 3.00 (2.00, 4.00) and (66.71±5.37) points respectively, which were better than those of western medicine group 4.00 (3.00, 5.00) and (64.03±5.57) points, and the differences were statistically significant (P<0.05). Hb of combined group at 7, 14, and 42 days after operation were (110.09±13.21), (113.19±12.08), and (129.58±12.50) g·L^-1 respectively, while those of western medicine group were (106.91±12.88), (111.72±10.29), and (131.71±12.64) g·L^-1 respectively;postoperative Hb of both groups at 7 and 14 days were lower than those before operation and 42 days after operation, and the differences were statistically significant (P<0.05). Postoperative PLT levels of combined group at 7, 14, and 42 days were(234.12±74.03), (292.09±71.32), and 217.50 (185.75, 248.75) × 10⁹·L^-1, respectively;while western medicine group were (246.03±56.84), (322.06±78.72), and 213.00 (183.50, 257.50)×10⁹·L^-1, respectively;postoperative PLT levels of both groups at 14 days were higher than those before operation, 7 and 42 days after operation, and the differences were statistically significant (P<0.05). Postoperative PT and APTT of combined group at 7 and 14 days were 13.30(12.30, 14.20), 12.95(12.30, 14.05) and 32.20 (28.75, 34.60), 30.80 (28.48, 34.88), respectively;which were higher than those of western medicine group 12.50(11.85, 13.20), 12.15 (11.80, 12.70) and 29.50 (26.25, 33.25), 28.10 (26.80, 29.55);postoperative PT and APTT of both groups at 7 and 14 days were higher than those before operation and 42 days after operation, and the differences were statistically significant (P<0.05). At 7 days after operation, the levels of P-selectin, PSGL-1 and H3Cit in combined group were (5 559.00±378.79), 504.22 (485.58, 529.89), and 267.60(256.22, 296.49) respectively, which were lower than those in western medicine group (5, 814.87±442.42), 551.04 (509.64, 585.21), and 288.20 (269.46, 310.03), the differences were statistically significant (P<0.05);vWF level in combined treatment group (484.65±35.15) was higher than that in western medicine group (461.08±31.16), and the difference was statistically significant (P<0.05). The number of intermuscular venous thrombosis in combined group at 14 and 42 days after operation was 4 (11.76%) and 1 (2.94%), respectively, while in western medicine group was 9 (26.47%) and 2 (5.89%), respectively. Relative risk(RR) analysis values at 14 and 42 days were 2.7[95%CI (0.742, 9.827)] and 2.06 [95%CI (0.178, 23.882)].

Conclusion: Peiyuan Fubai decoction () combined with rivaroxaban could prolong PT and APTT. By regulating P-selectin/PSGL-1 pathway and reducing expression of H3Cit, it could effectively prevent thrombosis formation after TKA, alleviate postoperative pain, promote functional recovery.