Haydock Maria Monica, Elhamdani Shahed, Alsharedi Mohamed
Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK.
Allegheny General Hospital, Pittsburgh, PA, USA.
SAGE Open Med Case Rep. 2019 Feb 4;7:2050313X19827747. doi: 10.1177/2050313X19827747. eCollection 2019.
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.
骨坏死是一种病理状态，可导致使人衰弱的身体疾病并妨碍日常活动。它通常根据病因分为原发性（特发性）或继发性。当骨血管的直接损伤或骨髓的直接损伤与可识别的原因相关，如创伤性损伤、使用类固醇或双膦酸盐、饮酒增加、镰状细胞病、自身免疫性疾病、化疗或恶性肿瘤时，它被归类为继发性骨坏死。另一方面，其发病机制尚未完全了解的骨坏死被归类为原发性或特发性骨坏死。这一类别包括遗传性血栓形成倾向和低纤维蛋白溶解作为潜在原因。对于因血栓形成倾向或低纤维蛋白溶解导致的原发性骨坏死的抗凝治疗及持续时间，尚无明确的指南或普遍共识。我们报告一例与低纤维蛋白溶解相关的原发性骨坏死病例，并通过终身直接口服抗凝治疗成功控制病情。
