Thrombophilia, hypofibrinolysis, and alveolar osteonecrosis of the jaws.
OBJECTIVE
Our specific aim in 49 patients (42 women, 7 men) with osteonecrosis of the jaw was to determine whether thrombophilia (increased tendency to intravascular thrombosis) or hypofibrinolysis (reduced ability to lyse thrombi) were associated with this regional avascular necrosis.


METHODS
Determinants of thrombosis and fibrinolysis were compared in healthy controls and in 42 women and 7 men who had biopsy-proven idiopathic osteonecrosis of the jaw with severe chronic jaw or facial pain syndromes and failure to respond to conventional medical and dental treatments.


RESULTS
Of the 49 patients, 35 (71%) had thrombophilia or hypofibrinolysis and only 14 were normal. Thrombophilia as a sole coagulation defect was found in 10 patients, 7 with resistance to activated protein C and 3 with low protein C (deficiency of an antithrombotic protein). Hypofibrinolysis with low stimulated tissue plasminogen activator activity and high lipoprotein (a) (an atherogenic, hypofibrinolytic lipoprotein) were found as sole coagulation defects in seven and eight patients, respectively. Ten patients had mixed defects; 7 of these 10 had thrombophilia with resistance to activated protein C. Sinusoidal dilatation was a constant feature in maxillary and mandibular bone biopsies, suggesting venous occlusion with intramedullary hypertension. Marrow fibrosis and occasional fibrin plugs were additional microscopic features believed to impair venous drainage and to contribute to ischemic necrosis of the alveolar bone.


CONCLUSIONS
Primary thrombophilia and hypofibrinolysis appear to be common, heritable, pathophysiologic risk factors for idiopathic osteonecrosis of the jaws. These coagulation defects may also contribute to alveolar neuralgia, atypical odontalgia and facial neuralgia, idiopathic trigeminal neuralgia, and to treatment failures so often encountered in patients with alveolar osteonecrosis and disabling chronic facial and jawbone pain syndromes.
Glueck
C J
CJ
Cholesterol Center, Jewish Hospital, Cincinnati, Ohio, USA.
McMahon
R E
RE
Bouquot
J
J
Stroop
D
D
Tracy
T
T
Wang
P
P
Rabinovich
B
B
D000328:Adult; D000368:Aged; D000539:Alveolar Process / Q000098:blood supply; D001796:Blood Protein Disorders / Q000150:complications*; D001853:Bone Marrow / Q000098:blood supply; D016009:Chi-Square Distribution; D004198:Disease Susceptibility / Q000097:blood; D005157:Facial Pain / Q000097:blood / Q000209:etiology; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D007571:Jaw Diseases / Q000097:blood / Q000209:etiology*; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000097:blood / Q000209:etiology*; D011486:Protein C / Q000378:metabolism; D020151:Protein C Deficiency; D013927:Thrombosis / Q000097:blood / Q000150:complications*; D010959:Tissue Plasminogen Activator / Q000037:antagonists & inhibitors / Q000172:deficiency
D017270:Lipoprotein(a); D011486:Protein C; D010959:Tissue Plasminogen Activator