{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:56:53Z","timestamp":1790056613481,"version":"4.0.1"},"reference-count":132,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T00:00:00Z","timestamp":1624492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Osteonecrosis of the femoral head (ONFH) is a debilitating disease with major social and economic impacts. It frequently affects relatively young adults and has a predilection for rapid progression to femoral head collapse and end-stage hip arthritis. If not diagnosed and treated properly in the early stages, ONFH has devastating consequences and leads to mandatory total hip arthroplasty. The pathophysiology of non-traumatic ONFH is very complex and not fully understood. While multiple risk factors have been associated with secondary ONFH, there are still many cases in which a clear etiology cannot be established. Recognition of the prothrombotic state as part of the etiopathogeny of primary ONFH provides an opportunity for early medical intervention, with implications for both prophylaxis and therapy aimed at slowing or stopping the progression of the disease. Hereditary thrombophilia and hypofibrinolysis are associated with thrombotic occlusion of bone vessels. Anticoagulant treatment can change the natural course of the disease and improve patients\u2019 quality of life. The present work focused on highlighting the association between hereditary thrombophilia\/hypofibrinolysis states and ONFH, emphasizing the importance of identifying this condition. We have also provided strong arguments to support the efficiency and safety of anticoagulant treatment in the early stages of the disease, encouraging etiological diagnosis and prompt therapeutic intervention. In the era of direct oral anticoagulants, new therapeutic options have become available, enabling better long-term compliance.<\/jats:p>","DOI":"10.3390\/ijms22136801","type":"journal-article","created":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T23:22:14Z","timestamp":1624576934000},"page":"6801","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Osteonecrosis of the Femoral Head in Patients with Hypercoagulability\u2014From Pathophysiology to Therapeutic Implications"],"prefix":"10.3390","volume":"22","author":[{"given":"Elena","family":"Rezus","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Physiotherapy, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Ia\u0219i, 16 University Street, 700115 Iasi, Romania"},{"name":"I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9868-1999","authenticated-orcid":false,"given":"Bogdan Ionel","family":"Tamba","sequence":"additional","affiliation":[{"name":"Advanced Center for Research and Development in Experimental Medicine (CEMEX), \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Iasi, 9-13 Mihail Kog\u0103lniceanu Street, 700454 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8942-1909","authenticated-orcid":false,"given":"Minerva Codruta","family":"Badescu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania"},{"name":"III Internal Medicine Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Popescu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania"},{"name":"III Internal Medicine Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Bratoiu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Physiotherapy, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy Ia\u0219i, 16 University Street, 700115 Iasi, Romania"},{"name":"I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciprian","family":"Rezus","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania"},{"name":"III Internal Medicine Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s00198-009-1003-1","article-title":"The epidemiology of osteonecrosis: Findings from the GPRD and THIN databases in the UK","volume":"21","author":"Cooper","year":"2010","journal-title":"Osteoporos. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.2106\/JBJS.O.00071","article-title":"Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update","volume":"97","author":"Mont","year":"2015","journal-title":"J. Bone Jt. Surg. 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