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Case Reports
. 2019 Feb 4:7:2050313X19827747.
doi: 10.1177/2050313X19827747. eCollection 2019.

Long-term direct oral anticoagulation in primary osteonecrosis with elevated plasminogen activation inhibitor

Maria Monica Haydock  1 , Shahed Elhamdani  2 , Mohamed Alsharedi  3
Affiliations
Case Reports

Long-term direct oral anticoagulation in primary osteonecrosis with elevated plasminogen activation inhibitor

Maria Monica Haydock et al. SAGE Open Med Case Rep. .

Abstract

Osteonecrosis is a pathological condition that could lead to a debilitating physical disease and impede daily activities. It is generally categorised into aetiology - primary (idiopathic) or secondary. When direct damage to the bone vasculature or direct injury of the bone marrow is related to an identifiable cause such as traumatic injuries, steroid or bisphosphonate use, increased alcohol intake, sickle cell disease, autoimmune diseases, chemotherapy or malignancy, it is categorised as secondary osteonecrosis. On the other hand, osteonecrosis wherein the mechanisms of development are not fully understood is categorised as primary or idiopathic osteonecrosis. This category includes inherited thrombophilia and hypofibrinolysis as potential causes. There are no clear guidelines or general agreements about anticoagulation treatment and duration in primary osteonecrosis due to thrombophilia or hypofibrinolysis. We report a case of primary osteonecrosis associated with hypofibrinolysis and successful control with lifelong direct oral anticoagulation therapy.

Keywords: Haematology; anticoagulation; direct oral anticoagulants; occupational therapy; orthopaedics; osteonecrosis; rehabilitation.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
MRI revealed bilateral abnormal signal intensities in the distal femurs, suggesting osteonecrosis.
Figure 2.
Figure 2.
The lesion on the left distal femur was larger and was the main source of the patient’s pain.
See this image and copyright information in PMC

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