Document Detail

Thrombophilia and hypofibrinolysis: pathophysiologies of osteonecrosis.
MedLine Citation:
PMID:  9005895     Owner:  NLM     Status:  MEDLINE    
In 31 patients with osteonecrosis (primarily of the hip), 74% had 1 or more primary coagulation disorders. In 18 patients, 15 (83%) who had coagulation disorders, the osteonecrosis was initially identified as idiopathic and was not associated with known underlying drugs (glucocorticoids) or diseases (alcoholism, sickle cell disease, Gaucher's disease). In 13 patients, 8 (62 %) who had coagulation disorders, the osteonecrosis was initially identified as secondary, and was associated with glucocorticoids in 12 patients, and with alcoholism in 1. The coagulation disorders included thrombhophilia (increased tendency to intravascular thrombosis) and hypofibrinolysis (reduced ability to lyse thrombi). Of the 18 patients initially thought to have idiopathic osteonecrosis, thrombophilia alone was found in 12% (resistance to activated protein C in 6%, low protein C in 6%), hypofibrinolysis alone was found in 50% (high lipoprotein(a) in 44%, low stimulated tissue plasminogen activator activity was found in 6%), and mixed thrombophilia hypofibrinolysis was found in 22%. Resistance to activated protein C was more common in these 18 patients than in healthy controls (11% versus 0%), as was high lipoprotein(a) (67% versus 20%). Of the 13 patients with secondary osteonecrosis, thrombophilia alone was found in 8% (low protein C), hypofibrinolysis alone was found in 30% (high Lp(a) in 15%, low tissue plasminogen activator activity in 15%), and mixed thrombophilia hypofibrinolysis was found in 23%. Low tissue plasminogen activator activity was more common in the 13 patients with secondary osteonecrosis than in controls (27% versus 7%), as was low protein C (23% versus 0%). In aggregate, these findings lead us to the speculation that primary, heritable thrombophilia or hypofibrinolysis causes thrombotic venous occlusion in the head of the femur, leading to venous hypertension and hypoxic death of bone (osteonecrosis).
C J Glueck; R Freiberg; T Tracy; D Stroop; P Wang
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  -     ISSN:  0009-921X     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-02-18     Completed Date:  1997-02-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  43-56     Citation Subset:  AIM; IM    
Cholesterol Center, Jewish Hospital, Cincinnati, OH 45229, USA.
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MeSH Terms
Anticoagulants / pharmacology
Blood Coagulation
Femur Head Necrosis / physiopathology
Fibrinolysis* / drug effects
Glucocorticoids / adverse effects
Lipoprotein(a) / blood
Middle Aged
Osteonecrosis / physiopathology*
Protein C / pharmacology
Risk Factors
Thrombosis / physiopathology*
Tissue Plasminogen Activator / blood
Warfarin / pharmacology
Reg. No./Substance:
0/Anticoagulants; 0/Glucocorticoids; 0/Lipoprotein(a); 0/Protein C; 81-81-2/Warfarin; EC Plasminogen Activator

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