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Vitamin K-Dependent Coagulopathy in Pediatric OsteomyelitisA Case Report
Megan E. Mignemi, MD1; Neal W. Langdon, BS2; Jonathan G. Schoenecker, MD, PhD3
1 Vanderbilt Orthopaedic Institute, Medical Center East, South Tower, Suite 4200, 1215 21st Avenue South, Nashville, TN 37232. E-mail address: Megan.mignemi@vanderbilt.edu
2 Vanderbilt University School of Medicine, 215 Light Hall, Nashville, TN 37232. E-mail address: Weston.langdon@vanderbilt.edu
3 Vanderbilt Orthopaedic Institute, Monroe Carell Jr. Children’s Hospital, 4202 Doctors’ Office Tower, 2200 Children’s Way, Nashville, TN 37232. E-mail address: Jonathan.schoenecker@vanderbilt.edu
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Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Mar 13;3(1):e21 1-6. doi: 10.2106/JBJS.CC.L.00169
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Thromboembolism in children is rare and is generally limited to those with genetic disorders of coagulation and diseases that induce a hypercoagulable state1. The incidence of deep vein thrombosis (DVT) in children with osteomyelitis is reported to be much higher (between 5% and 10%) 2-4. In addition to DVT, there are other coagulation abnormalities that occur with osteomyelitis that are often paradoxically “mixed” and include features of hypercoagulability (such as pulmonary embolus and cerebral infarct5) and hypocoagulability with increased risk of bleeding4,6-11. The pathophysiology behind the coagulopathy associated with osteomyelitis is unknown.
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