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Apostu D, Berechet B, Oltean-Dan D, Mester A, Petrushev B, Popa C, Gherman ML, Tigu AB, Tomuleasa CI, Barbu-Tudoran L, Benea HRC, Piciu D. Low-Molecular-Weight Heparins (LMWH) and Synthetic Factor X Inhibitors Can Impair the Osseointegration Process of a Titanium Implant in an Interventional Animal Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1590. [PMID: 36363548 PMCID: PMC9694659 DOI: 10.3390/medicina58111590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 08/30/2023]
Abstract
Background and objectives: Cementless total hip arthroplasty is a common surgical procedure and perioperative thromboprophylaxis is used to prevent deep vein thrombosis or pulmonary embolism. Osseointegration is important for long-term implant survival, and there is no research on the effect of different thromboprophylaxis agents on the process of osseointegration. Materials and Methods: Seventy rats were allocated as follows: Group I (control group), Group II (enoxaparin), Group III (nadroparin), and Group IV (fondaparinux). Ovariectomy was performed on all subjects, followed by the introduction of an intramedullary titanium implant into the femur. Thromboprophylaxis was administered accordingly to each treatment group for 35 days postoperatively. Results: Group I had statistically significantly lower anti-Xa levels compared to treatment groups. Micro-CT analysis showed that nadroparin had lower values compared to control in bone volume (0.12 vs. 0.21, p = 0.01) and percent bone volume (1.46 vs. 1.93, p = 0.047). The pull-out test showed statistically significant differences between the control group (8.81 N) compared to enoxaparin, nadroparin, and fondaparinux groups (4.53 N, 4 N and 4.07 N, respectively). Nadroparin had a lower histological cortical bone tissue and a higher width of fibrous tissue (27.49 μm and 86.9 μm) at the peri-implant area, compared to control (43.2 μm and 39.2 μm), enoxaparin (39.6 μm and 24 μm), and fondaparinux (36.2 μm and 32.7 μm). Conclusions: Short-term administration of enoxaparin, nadroparin, and fondaparinux can reduce the osseointegration of titanium implants, with nadroparin having the most negative effect. These results show that enoxaparin and fondaparinux are preferred to be administered due to a lesser negative impact on the initial implant fixation.
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Affiliation(s)
- Dragos Apostu
- Department of Orthopedics, Traumatology and Pediatric Orthopaedics, University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Bianca Berechet
- Department of Gastroenterology, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400347 Cluj-Napoca, Romania
| | - Daniel Oltean-Dan
- Department of Orthopedics, Traumatology and Pediatric Orthopaedics, University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Alexandru Mester
- Department of Oral Health, University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Bobe Petrushev
- Department of Gastroenterology, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400347 Cluj-Napoca, Romania
| | - Catalin Popa
- Department of Materials Science and Engineering, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Madalina Luciana Gherman
- Experimental Center, University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Adrian Bogdan Tigu
- Research Center for Advanced Medicine—MedFuture, Department of Translational Medicine, University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Ciprian Ionut Tomuleasa
- Department of Hematology, University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400015 Cluj-Napoca, Romania
- Medfuture Research Center for Advanced Medicine, University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Lucian Barbu-Tudoran
- Electron Microscopy Center, Faculty of Biology and Geology, Babes-Bolyai University, 400006 Cluj-Napoca, Romania
| | - Horea Rares Ciprian Benea
- Department of Orthopedics, Traumatology and Pediatric Orthopaedics, University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Doina Piciu
- Nuclear Medicine Department, University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
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Chaverri D, Vives J. Toward the clinical use of circulating biomarkers predictive of bone union. Biomark Med 2017; 11:1125-1133. [PMID: 29182015 DOI: 10.2217/bmm-2017-0180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Current methods for diagnosis of bone healing after treatment of trauma injuries rely on clinical findings and the use of imaging methodologies that provide conclusive results but only at mid/long-term post-intervention. In this Perspective we present and discuss incipient evidence on biomarkers that may serve for monitoring the progression of bone healing as well as predicting eventual nonunion outcomes.
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Affiliation(s)
- Daniel Chaverri
- Hospital ASEPEYO Sant Cugat, Avinguda Alcalde Barnils, 54-60, Sant Cugat del Vallès, 08174 Barcelona, Spain
| | - Joaquim Vives
- Servei de Teràpia Cel·lular, Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Passeig Taulat, 116, 08005 Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 129-139, 08035 Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 129-139, 08035 Barcelona, Spain
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Kapetanakis S, Nastoulis E, Demesticha T, Demetriou T. The Effect of Low Molecular Weight Heparins on Fracture Healing. Open Orthop J 2015; 9:226-36. [PMID: 26161162 PMCID: PMC4493651 DOI: 10.2174/1874325001509010226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/27/2015] [Accepted: 04/20/2015] [Indexed: 01/08/2023] Open
Abstract
Venous Thromboembolism is a serious complication in the trauma patient. The most commonly studied and used anticoagulant treatment in prophylaxis of thrombosis is heparin. The prolonged use of unfractionated heparin has been connected with increased incidence of osteoporotic fractures. Low molecular-weight-heparins (LMWHs) have been the golden rule in antithrombotic therapy during the previous two decades as a way to overcome the major drawbacks of unfractioned heparin. However there are few studies reporting the effects of LMWHs on bone repair after fractures. This review presents the studies about the effects of LMWHs on bone biology (bone cells and bone metabolism) and underlying the mechanisms by which LMWHs may impair fracture healing process. The authors' research based on literature concluded that there are no facts and statistics for the role of LMWHs on fracture healing process in humans and the main body of evidence of their role comes from in vitro and animal studies. Further large clinical studies designed to compare different types of LMWHs, in different dosages and in different patient or animal models are needed for exploring the effects of LMWHs on fracture healing process.
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Affiliation(s)
- Stylianos Kapetanakis
- Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelos Nastoulis
- Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theano Demesticha
- Department of Anatomy, Medical School, Faculty of Medicine Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Thespis Demetriou
- Department of Anatomy, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Klüter T, Weuster M, Brüggemann S, Menzdorf L, Fitschen-Oestern S, Steubesand N, Acil Y, Pufe T, Varoga D, Seekamp A, Lippross S. Rivaroxaban does not impair fracture healing in a rat femur fracture model: an experimental study. BMC Musculoskelet Disord 2015; 16:79. [PMID: 25886252 PMCID: PMC4404693 DOI: 10.1186/s12891-015-0502-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/13/2015] [Indexed: 11/11/2022] Open
Abstract
Background The prescription of the oral anticoagulant rivaroxaban to prevent thromboembolic episodes associated with orthopaedic surgery has dramatically increased since it was introduced. Rivaroxaban is beeing prescribed although recent in-vitro studies revealed that it impaired osteoblast metabolism. In this study we analysed the effect of rivaroxaban on fracture healing in a rat femur fracture model. Methods Femur fractures were created by a 3-point-bending device in 48 Wistar rats and subsequently stabilized by intramedullary nailing. After the surgical procedure animals were randomised into four groups. Two groups were fed with 3 mg rivaroxaban per kg body weight per day and two control groups were fed with chow only. Animals were euthanized 28 or 49 days after surgical procedure. Femurs underwent undecalcified histologic staining micro CT scanning and biomechanical testing. The statistical significance was evaluated using one-way Anova with Bonferroni correction. Results Micro CT-scans revealed significantly increased volume of bone tissue in the fracture zone between day 28 and 49. During the same time callus volume decreased significantly. Comparing the fracture zone of the rivaroxaban group to the control group the treated group revealed a larger callus and a marginal increase of the tissue mineral density. The torsional rigidity was not influenced by the treatment of rivaroxaban. Conclusion In the present study we were able to demonstrate that rivaroxaban does not impair fracture healing in a rat femur fracture model. Considering the fact that low molecular weight heparins delay fracture healing significantly, rivaroxaban might be an improved alternative.
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Affiliation(s)
- Tim Klüter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Matthias Weuster
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Stefan Brüggemann
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Leif Menzdorf
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Stefanie Fitschen-Oestern
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Nadine Steubesand
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Yahya Acil
- Department of Maxillo-Facialy, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Thomas Pufe
- Department of Anatomy and Cell Biology, RWTH Aachen University, Aachen, Germany.
| | - Deike Varoga
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
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