A Successful Collaborative Approach to the Perioperative Management After Hip Arthroscopy of a Patient with Heterozygous Prothrombin G20210A Mutation: A Case Report

JBJS Case Connect. 2019 Apr-Jun;9(2):e0376. doi: 10.2106/JBJS.CC.18.00376.

Abstract

Case: We report on a patient with heterozygous prothrombin G20210A mutation (PTM) and a history of venous thromboembolism (VTE) after knee arthroscopy, who was undergoing hip arthroscopy. This common mutation has an overall prevalence of 2.0% and results in a 280% to 420% likelihood of thrombosis compared to patients without the mutation.

Conclusions: Hip arthroscopy is associated with a low risk of VTE with currently no guidelines for thromboprophylaxis. Patients should be managed in relation to their risk factors utilizing a collaborative, individualized approach. Treatment with short-term low-molecular-weight heparin resulted in no thromboembolism at 18-month follow-up for this patient with PTM.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Aftercare
  • Anticoagulants / therapeutic use
  • Arthroscopy / adverse effects*
  • Arthroscopy / methods
  • Female
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Heterozygote
  • Hip Joint / diagnostic imaging*
  • Hip Joint / pathology
  • Hip Joint / surgery
  • Humans
  • Interdisciplinary Placement / methods
  • Mutation / genetics
  • Perioperative Care / methods*
  • Risk Factors
  • Thrombophilia / drug therapy
  • Thrombophilia / epidemiology
  • Thrombophilia / genetics*
  • Treatment Outcome
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight

Supplementary concepts

  • Hyperprothrombinemia