Altered clotting factors contribute to the development of avascular necrosis
Multiple clinical reviews and studies demonstrate that coagulopathies, thrombotic events, and altered clotting factors play a major role in causing the localized ischemia that leads to avascular necrosis.
The retrieved literature consistently supports the claim that altered clotting factors and prothrombotic states (coagulopathy) contribute to the development of avascular necrosis across various joints and underlying conditions (such as ANFH, ONJ, and LCPD).
Singh M, Singh B, Sharma K, Kumar N, Mastana S, Singh P. A Molecular Troika of Angiogenesis, Coagulopathy and Endothelial Dysfunction in the Pathology of Avascular Necrosis of Femoral Head: A Comprehensive Review.. 2023. https://doi.org/10.3390/cells12182278
Paper 0 establishes that coagulopathy and thrombus formation are key elements of the molecular triad contributing to the pathology of avascular necrosis of the femoral head.
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Badescu MC, Rezus E, Ciocoiu M, Badulescu OV, Butnariu LI, Popescu D, Bratoiu I, Rezus C. Osteonecrosis of the Jaws in Patients with Hereditary Thrombophilia/Hypofibrinolysis-From Pathophysiology to Therapeutic Implications.. 2022. https://doi.org/10.3390/ijms23020640
Paper 1 finds that thrombotic occlusion and hereditary prothrombotic abnormalities significantly contribute to osteonecrosis development and treatment refractoriness.
Evangelidis P, Gavriilaki E, Kotsiou N, Ntova Z, Kalmoukos P, Papadopoulou T, Chissan S, Vakalopoulou S. Avascular Necrosis of the Femoral Head in Patients with Antiphospholipid Syndrome: A Case Series.. 2025. https://doi.org/10.3390/hematolrep17020015
Paper 2 demonstrates through a clinical case series that avascular necrosis can manifest as a complication in systemic conditions like antiphospholipid syndrome characterized by thrombosis.
Shah SS, Ahsan M, Farooq T, Baig MD, Baig MMA, Amin MHJ. Bilateral Avascular Necrosis of the Femoral Heads in Ankylosing Spondylitis Requiring Staged Total Hip Arthroplasty: A Case Report of Diagnostic and Therapeutic Challenges.. 2026. https://doi.org/10.1002/ccr3.72801
Paper 7 notes that a prothrombotic state is a recognized factor in the multifactorial pathogenesis of avascular necrosis in patients with ankylosing spondylitis.
Rodríguez-Olivas AO, Reyes-Maldonado E, Casas-Ávila L, Galicia-Alvarado MA, Rosales-Cruz E, Zavala-Hernández C, Hernández-Zamora E. Association of <i>IL-23R</i> rs1569922 and Other Probable Frequent Etiological Factors with Legg-Calvé-Perthes Disease in Mexican Patients.. 2025. https://doi.org/10.3390/genes16101126
Paper 10 reports that patients with Legg-Calvé-Perthes disease (a form of avascular osteonecrosis) exhibit hypercoagulable states and alterations in hemostatic factors.
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