[Vertebral fractures combined with prolonged activated partial prothrombin time: A case report]

Area of Science:

• Rheumatology
• Orthopedics
• Hematology

Background:

• Autoimmune diseases and glucocorticoid use increase osteoporosis risk, leading to vertebral fractures.
• Osteoporotic vertebral compression fractures are often treated with minimally invasive procedures like percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP).
• These procedures carry risks, including bleeding and cement leakage, necessitating thorough preoperative evaluation, especially for coagulation status.

Observation:

• A case report details an autoimmune disease patient with Sjögren's syndrome and a lumbar vertebral fracture.
• Preoperative tests revealed significantly prolonged activated partial thromboplastin time (APTT).
• Further investigation identified lupus anticoagulant (LAC), leading to a diagnosis of antiphospholipid syndrome (APS).

Findings:

• Antiphospholipid syndrome (APS) in autoimmune patients presents a complex risk profile, balancing bleeding tendencies with a high risk of thrombosis.
• Careful preoperative assessment and multidisciplinary evaluation are essential for patients with autoimmune diseases and prolonged APTT.
• Timely anticoagulation management is critical for mitigating perioperative complications in such cases.

Implications:

• Accurate diagnosis of the cause of prolonged APTT in autoimmune patients is vital for targeted treatment.
• Understanding and managing the dual risks of bleeding and clotting in APS patients undergoing orthopedic procedures is paramount.
• This case highlights the importance of a multidisciplinary approach to optimize surgical outcomes and patient safety.