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Long term anticoagulation (4-16 years) stops progression of idiopathic hip osteonecrosis associated with familial thrombophilia.

Glueck CJ, Freiberg RA, Wissman R, Wang P - Adv Orthop (2015)

Bottom Line: Four men and 2 women (9 hips, 8 Ficat stage II, 1 stage I) were anticoagulated with enoxaparin (60 mg/day) for 3 months and subsequently with Coumadin, Xarelto, or Pradaxa, warranted by ≥2 prior thrombotic events.On 4-16-years anticoagulation, 9 hips in the 6 patients (8 originally Ficat II, 1 Ficat I) remained unchanged, contrasted to untreated ON Ficat stage II, where 50%-80% of hips progress to collapse (Ficat stages III-IV) within 2 years after diagnosis.There were no significant bleeding episodes.

View Article: PubMed Central - PubMed

Affiliation: The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Cincinnati, OH 45207, USA.

ABSTRACT
In 6 patients with familial thrombophilia (5 Factor V (FV) Leiden heterozygotes, 1 with resistance to activated protein C (RAPC)), we prospectively assessed whether continuous longterm (4-16 years) anticoagulation would prevent progression of idiopathic osteonecrosis (ON), ameliorate pain, and facilitate functional recovery. Four men and 2 women (9 hips, 8 Ficat stage II, 1 stage I) were anticoagulated with enoxaparin (60 mg/day) for 3 months and subsequently with Coumadin, Xarelto, or Pradaxa, warranted by ≥2 prior thrombotic events. Anticoagulation was continued for 4, 4, 9, 13, 13, and 16 years, with serial clinical and X-ray follow-up. On 4-16-years anticoagulation, 9 hips in the 6 patients (8 originally Ficat II, 1 Ficat I) remained unchanged, contrasted to untreated ON Ficat stage II, where 50%-80% of hips progress to collapse (Ficat stages III-IV) within 2 years after diagnosis. Within 3, 3, 3, 9, and 16 months after starting anticoagulation, 5 patients became pain-free and remained asymptomatic throughout follow-up; the 6th patient required Percocet for pain. There were no significant bleeding episodes. Long term (4-16 years) anticoagulation initiated in Ficat stages I-II of idiopathic hip ON in patients with FV-RAPC changes the natural history of ON, stopping progression, resolving pain, and restoring function.

No MeSH data available.


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Anterior-posterior hip X-rays in patient number 3 at preanticoagulation study entry: both hips are Ficat stage II.
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fig1: Anterior-posterior hip X-rays in patient number 3 at preanticoagulation study entry: both hips are Ficat stage II.

Mentions: At follow-up of 4, 4, 9, 13, 13, and 16 years, respectively, Ficat staging remained unchanged from preanticoagulation study entry (Ficat stages I-II), with no hip collapse and no progression to osteoarthritis (Table 1). At 4-year follow-up in Cases numbers 1 and 2, preanticoagulation Ficat stages (I, II) were unchanged (Table 1). Comparing preanticoagulation entry and 9-year follow-up X-rays in Case number 3 revealed no change in Ficat stage II ON (Figures 1 and 2, Table 1). Comparing preanticoagulation entry and 5- and 13-year follow-up X-rays in Case number 4 (Figures 3, 4, and 5) revealed no change in Ficat stage II ON of the right hip in 5 and 13 years. The left hip, Ficat stage III at preanticoagulation entry (Figure 3), was replaced before entry into the anticoagulant trial (Figure 4).


Long term anticoagulation (4-16 years) stops progression of idiopathic hip osteonecrosis associated with familial thrombophilia.

Glueck CJ, Freiberg RA, Wissman R, Wang P - Adv Orthop (2015)

Anterior-posterior hip X-rays in patient number 3 at preanticoagulation study entry: both hips are Ficat stage II.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4325553&req=5

fig1: Anterior-posterior hip X-rays in patient number 3 at preanticoagulation study entry: both hips are Ficat stage II.
Mentions: At follow-up of 4, 4, 9, 13, 13, and 16 years, respectively, Ficat staging remained unchanged from preanticoagulation study entry (Ficat stages I-II), with no hip collapse and no progression to osteoarthritis (Table 1). At 4-year follow-up in Cases numbers 1 and 2, preanticoagulation Ficat stages (I, II) were unchanged (Table 1). Comparing preanticoagulation entry and 9-year follow-up X-rays in Case number 3 revealed no change in Ficat stage II ON (Figures 1 and 2, Table 1). Comparing preanticoagulation entry and 5- and 13-year follow-up X-rays in Case number 4 (Figures 3, 4, and 5) revealed no change in Ficat stage II ON of the right hip in 5 and 13 years. The left hip, Ficat stage III at preanticoagulation entry (Figure 3), was replaced before entry into the anticoagulant trial (Figure 4).

Bottom Line: Four men and 2 women (9 hips, 8 Ficat stage II, 1 stage I) were anticoagulated with enoxaparin (60 mg/day) for 3 months and subsequently with Coumadin, Xarelto, or Pradaxa, warranted by ≥2 prior thrombotic events.On 4-16-years anticoagulation, 9 hips in the 6 patients (8 originally Ficat II, 1 Ficat I) remained unchanged, contrasted to untreated ON Ficat stage II, where 50%-80% of hips progress to collapse (Ficat stages III-IV) within 2 years after diagnosis.There were no significant bleeding episodes.

View Article: PubMed Central - PubMed

Affiliation: The Cholesterol, Metabolism, and Thrombosis Center, Jewish Hospital of Cincinnati, Cincinnati, OH 45207, USA.

ABSTRACT
In 6 patients with familial thrombophilia (5 Factor V (FV) Leiden heterozygotes, 1 with resistance to activated protein C (RAPC)), we prospectively assessed whether continuous longterm (4-16 years) anticoagulation would prevent progression of idiopathic osteonecrosis (ON), ameliorate pain, and facilitate functional recovery. Four men and 2 women (9 hips, 8 Ficat stage II, 1 stage I) were anticoagulated with enoxaparin (60 mg/day) for 3 months and subsequently with Coumadin, Xarelto, or Pradaxa, warranted by ≥2 prior thrombotic events. Anticoagulation was continued for 4, 4, 9, 13, 13, and 16 years, with serial clinical and X-ray follow-up. On 4-16-years anticoagulation, 9 hips in the 6 patients (8 originally Ficat II, 1 Ficat I) remained unchanged, contrasted to untreated ON Ficat stage II, where 50%-80% of hips progress to collapse (Ficat stages III-IV) within 2 years after diagnosis. Within 3, 3, 3, 9, and 16 months after starting anticoagulation, 5 patients became pain-free and remained asymptomatic throughout follow-up; the 6th patient required Percocet for pain. There were no significant bleeding episodes. Long term (4-16 years) anticoagulation initiated in Ficat stages I-II of idiopathic hip ON in patients with FV-RAPC changes the natural history of ON, stopping progression, resolving pain, and restoring function.

No MeSH data available.


Related in: MedlinePlus