Association Between Venous Mesenteric Thrombosis and Plasminogen Activator Inhibitor-1 Mutation.

Plasminogen activator inhibitor-1 (PAI-1) is central to fibrinolysis regulation, and genetic variants such as the 4G/4G genotype predispose individuals to hypercoagulability. This case highlights a 46-year-old female patient presenting with acute mesenteric venous thrombosis, where genetic evaluation revealed homozygosity for the PAI-1 4G/4G polymorphism. Management with unfractionated heparin followed by a transition to direct oral anticoagulants led to clinical resolution. This report underscores the role of PAI-1 polymorphisms in thrombotic pathophysiology and long-term anticoagulation therapy.