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Lack of efficacy: case report A study of nine patients with primary osteonecrosis of the hip associated with familial thrombophilia described a 48-year-old man, who exhibited a lack of efficacy during anticoagulation treatment with enoxaparin-sodium and warfarin for prevention of progression of familial thrombophilia-associated osteonecrosis [routes not stated, not all dosages stated]. The man had primary osteonecrosis of the hip (Ficat Stage I; RII and LII) associated with familial thrombophilia. From the experimental analysis, it was found that the venous occlusion due to familial thrombophilia might be a contributory factor to osteonecrosis. Therefore, he started receiving anticoagulation therapy with enoxaparin-sodium [Enoxaparin] 60mg daily for 3 months, for prevention of progression of familial thrombophilia-associated osteonecrosis. After 3 months, his anticoagulation therapy was changed to warfarin due to restrictions imposed by third-party medical insurers, with target INR of 2–2.5. During 11.5 years follow-up, even though there was no change in severity of osteonecrosis, he had persistent pain requiring paracetamol and oxycodone (lack of efficacy). Glueck CJ, et al. Long-term anticoagulation prevents progression of stages I and II primary osteonecrosis of the hip in patients with familial thrombophilia. Orthopedics 43: 803519962 E208-E214, No. 4, Jul-Aug 2020. Available from: URL: http://doi.org/10.3928/01477447-20200404-06

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Reactions 12 Dec 2020 No. 1834