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Jonas E, Masri D, Avishai G, Masri-Iraqi H, Chaushu G, Chaushu L. The impact of antiplatelet and anticoagulant medications on early implant failure following sinus floor augmentation: A retrospective cohort analysis. Clin Implant Dent Relat Res 2024; 26:1046-1055. [PMID: 39113390 DOI: 10.1111/cid.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 10/12/2024]
Abstract
INTRODUCTION The effect of antiplatelet and anticoagulant medications on the outcomes of sinus floor augmentation remains unclear. METHODS This retrospective cohort study analyzed data from electronic medical records of consecutive patients undergoing sinus floor augmentation at a single medical center. Patients were categorized into three categories: patients under antiplatelet medications, patients under anticoagulation medications, and healthy individuals. Data collected included tobacco smoking, residual alveolar bone height, timing of implant placement, materials used, vertical bone gain, early implant failure (EIF), and complications such as Schneiderian membrane perforation and postoperative bleeding. Multivariable analysis was performed to assess risk factors for EIF. Statistical significance was considered below 5%. RESULTS Among 110 patients with 305 implants, EIF occurred in 10% of patients and 4.65% of implants. No significant difference in postoperative bleeding or EIF was found between study groups. Univariate and multivariable analyses highlighted tobacco smoking (odds ratio [OR] = 7.92), lower residual alveolar ridge height (OR = 0.81), and staged implant placement (OR = 4.64) as significant EIF risk factors in this cohort. CONCLUSIONS Anticoagulant and antiplatelet therapies do not significantly elevate the risk of EIF or postoperative bleeding following sinus floor augmentation. Tobacco smoking, residual alveolar ridge height and staged sinus floor augmentation were risk factors for EIF in patients using antiplatelet or anticoagulation medications undergoing sinus floor augmentation.
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Affiliation(s)
- Ehud Jonas
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petah Tiqwa, Israel
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daya Masri
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petah Tiqwa, Israel
- Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Avishai
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petah Tiqwa, Israel
- Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hiba Masri-Iraqi
- Department of Endocrinology, Rabin Medical Center, Petah Tiqwa, Israel
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petah Tiqwa, Israel
- Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Chaushu
- Department of Periodontology and Implant Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Kyriakaki I, Karanikola T, Lillis T, Kontonasaki E, Dabarakis N. Effect of direct oral anticoagulant dabigatran on early bone healing: An experimental study in rats. JOURNAL OF ADVANCED PERIODONTOLOGY & IMPLANT DENTISTRY 2023; 15:86-92. [PMID: 38357331 PMCID: PMC10862050 DOI: 10.34172/japid.2023.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/30/2023] [Indexed: 02/16/2024]
Abstract
Background Dabigatran belongs to the new generation of direct oral anticoagulants (DOACs). Its advantages are oral administration and no need for international normalized ratio (INR) monitoring. Although its use has increased, its potential side effects on bone healing and remodeling have not been fully investigated. The present study aimed to evaluate the possible effects of dabigatran on early bone healing. Methods Sixteen male Wistar rats were divided into two groups; in group A, 20-mg/kg dabigatran dose was administered orally daily for 15 days, while group B served as a control. Two circular bone defects (d=6 mm) were created on either side of the parietal bones. Two weeks after surgery and euthanasia of the animals, tissue samples (parietal bones that contained the defects) were harvested for histological and histomorphometric analysis. Statistical analysis was performed with a significance level of α=0.5. Results No statistically significant differences were found between the two groups regarding the regenerated bone (21.9% vs. 16.3%, P=0.172) or the percentage of bone bridging (63.3% vs. 53.5%, P=0.401). Conclusion Dabigatran did not affect bone regeneration, suggesting that it might be a safer drug compared to older anticoagulants known to lead to bone healing delay.
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Affiliation(s)
- Ioanna Kyriakaki
- Department of Dentoalveolar Surgery, Surgical Implantology and Roentgenology, Aristotle University, Thessaloniki, Greece
| | - Theodora Karanikola
- Private Practice, Clinical Instructor, Department of Oral Surgery, Implantology and Dental Radiology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Lillis
- Department of Dentoalveolar Surgery, Surgical Implantology and Roentgenology, Aristotle University, Thessaloniki, Greece
| | - Eleana Kontonasaki
- Department of Prosthodontics, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Dabarakis
- Department of Dentoalveolar Surgery, Surgical Implantology and Roentgenology, Aristotle University, Thessaloniki, Greece
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Liu Y, Xie X, Bi S, Zhang Q, Song Q, Sun Y, Yu T. Risk of osteoporosis in patients treated with direct oral anticoagulants vs. warfarin: an analysis of observational studies. Front Endocrinol (Lausanne) 2023; 14:1212570. [PMID: 37842293 PMCID: PMC10570517 DOI: 10.3389/fendo.2023.1212570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/07/2023] [Indexed: 10/17/2023] Open
Abstract
Aims Evidence on the association between the risk of new-onset osteoporosis and oral anticoagulants remains controversial. We aimed to compare the risk of osteoporosis associated with the use of direct oral anticoagulants (DOACs) with that associated with warfarin use. Methods Studies published up to 15 March 2023 that investigated the association between the use of DOACs and warfarin and the incidence of osteoporosis were identified by online searches in PubMed, Embase, the Cochrane Library, and Web of Science conducted by two independent investigators. Random-effects or fixed-effect models were employed to synthesize hazard ratios (HRs)/relative ratios (RRs) with 95% confidence intervals (CIs) for estimating the risk of osteoporosis correlated with DOAC and warfarin prescriptions (PROSPERO No. CRD42023401199). Results Our meta-analysis ultimately included four studies involving 74,338 patients. The results suggested that DOAC use was associated with a significantly lower incidence of new-onset osteoporosis than warfarin use (pooled HR: 0.71, 95% CI: 0.57 to 0.88, p < 0.001, I 2: 85.1%). Subanalyses revealed that rivaroxaban was associated with a lower risk of osteoporosis than both warfarin and dabigatran. In addition, DOACs were associated with a lower risk of developing osteoporosis than warfarin in both male and female patients, in patients with atrial fibrillation (AF), and in patients who underwent therapy for > 365 days. Conclusion DOAC users experienced a lower incidence of osteoporosis than warfarin users. This study may give us insight into safe anticoagulation strategies for patients who are at high risk of developing osteoporosis. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023401199.
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Affiliation(s)
- Yumeng Liu
- Institute of Virology and AIDS Research, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Xiaoping Xie
- Department of Orthopedics, Orthopedics Center, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Songqi Bi
- Department of Orthopedics, Orthopedics Center, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Qiong Zhang
- Department of Orthopedics, Orthopedics Center, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Qingxu Song
- Department of Orthopedics, Orthopedics Center, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Yang Sun
- Department of Orthopedics, Orthopedics Center, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Tiecheng Yu
- Department of Orthopedics, Orthopedics Center, First Hospital of Jilin University, Jilin University, Changchun, China
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Chaushu L, Perez N, Botticelli D, Xavier SP, Kolerman R, Masri D. The Effect of Anticoagulants on Early Implant Failure: A Retrospective Cohort Study. J Funct Biomater 2023; 14:jfb14040186. [PMID: 37103275 PMCID: PMC10144258 DOI: 10.3390/jfb14040186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Anticoagulants (AC) are among the most often prescribed drugs in the world. Data regarding ACs’ effect on the osseointegration of dental implants is lacking. Purpose: The aim of the present retrospective cohort study was to evaluate the effect of anticoagulants (AC) on early implant failure (EIF). The null hypothesis was that the use of AC increases the incidence of EIF. Materials and Methods: The research included 687 patients who underwent 2971 dental implant placements in the department of oral and maxillofacial surgery in Rabin medical center, Beilinson hospital, by specialists in oral and maxillofacial surgery. The study group comprised 173 (25.2%) patients and 708 (23.8%) implants using AC. The rest of the cohort served as a control. A structured form was used to collect data at patient and implant level. EIF was defined as implant failure within a period of up to 12 months from loading. EIF was the primary outcome parameter. A logistic regression model was used to predict EIF. Results: Implants placed in individuals ≥ 80 (odds ratio (OR) = 0.34, p = 0.05), and ASA 2/3 vs. ASA 1 individuals (OR = 0.30, p = 0.02/OR = 0.33, p = 0.03, respectively) had decreased odds of EIF, and implants in those using anticoagulants (OR = 2.64, p = 0.01) had increased odds of EIF. At the patient level, the odds of EIF in ASA 3 (OR = 0.53, p = 0.02) and IHD (OR = 0.40, p = 0.02) individuals decreased. In AF/VF (OR = 2.95, p = 0.01) individuals, EIF odds increased. Conclusions: Within the limitations of the present study, the use of AC is significantly associated with an increased likelihood of EIF: the OR was 2.64. Future research is required to validate and examine the prospective impact of AC on the osseointegration phenomena.
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Debiève M, Castiaux L, van Maanen A, Magremanne M. Medication-related osteonecrosis of the jaw, a risk to reassess in osteoporotic patients. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101316. [PMID: 36273739 DOI: 10.1016/j.jormas.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The use of antiresorptive drugs concerns many medical specialties either in relation to their prescription for osteoporosis or cancer, or in relation to the treatment of their side effects. In the literature, less than 10% of medication-related osteonecrosis of the jaw are related to patients treated for osteoporosis, while 90% are found in patients treated for cancer. Despite the increasing number of osteoporotic patients taking high doses of antiresorptive drugs, only few studies describe this topic. The main aim of this study was to highlight the occurrence of medication-related osteonecrosis of the jaw in osteoporotic patients compared to cancer patients. The second aim was to highlight risk factors in the two groups, to try to understand the high number of osteoporotic patients in our population. MATERIALS AND METHODS A retrospective study was conducted between December 2004 and March 2021 to identify all cases of medication-related osteonecrosis of the jaw in our department with emphasis on the osteoporotic population. Demographic, systemic and local risk factors were collected as well as the type, dose and duration of the anti-resorptive drugs treatment. Evolution and follow-up were also recorded. RESULTS One hundred sixty five patients presented with medication-related osteonecrosis of the jaw, of whom 67 (40,6%) were osteoporotic. Seventeen (25,4%) patients were males and 50 females (74,6%). Risk factors were tobacco consumption (28,4%), anemia (20,9%), alcohol consumption (19,4%). Use of corticoids or anticoagulant/antithrombotic therapy was related in 20,9% and 16,4%, respectively. The mean age at MRONJ diagnosis was 74,4 (50-98). The mean follow up time was 23,7 months (1-110). CONCLUSION Unlike the literature where medication-related osteonecrosis of the jaw in osteoporotic patients represents less than 10%, the rate in our series was much higher and represents 40% of the patients. This highlights the importance of a complete dental examination before and during antiresorptive drugs treatment, even in the case of osteoporotic patients.
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Affiliation(s)
- M Debiève
- Department of Oral and Maxillo-Facial Surgery, Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium.
| | - L Castiaux
- Department of Oral and Maxillo-Facial Surgery, Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium
| | - A van Maanen
- Statistical Support Unit, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 200 Brussels, Belgium; Institut Roi Albert II, Cancérologie et Hématologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium
| | - M Magremanne
- Department of Oral and Maxillo-Facial Surgery, Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium; Institut Roi Albert II, Cancérologie et Hématologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium
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Sun P, Wu H, He H, Zhang L, Liu Y, Zhang C, Lou C, Li J, Bai H. Delivery of rivaroxaban and chitosan rapamycin microparticle with dual antithrombosis and antiproliferation functions inhibits venous neointimal hyperplasia. Drug Deliv 2022; 29:1994-2001. [PMID: 35762638 PMCID: PMC9246098 DOI: 10.1080/10717544.2022.2092240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Neointimal hyperplasia is a complex process after vascular interventions, acute platelet deposition and smooth muscle cell proliferation both contributed to this process. There are still no perfect solutions to solve this problem. Rivaroxaban is a novel anticoagulant that has been widely used in clinic, it has a good pharmacological effects both in vivo and in vitro. Chitosan microparticle rapamycin (MP-rapa) was fabricated, interspaces of polyglycolic acid (PGA) scaffold were used as a reservoir of MP-rapa, and the scaffold was coated with hyaluronic acid rivaroxaban (MP-rapa-riva). Scanning electronic microscopy (SEM) photographs were taken and water contact angles were measured, rat inferior vena cava (IVC) patch venoplasty model was used; patches were harvested at day 14 and examined by immunohistochemistry and immunofluorescence. SEM photographs showed the microparticles rapamycin were inside the interspace of the scaffold, hyaluronic acid rivaroxaban was also successfully coated onto the surface of the scaffold. There was a thinner neointima, fewer proliferating cell nuclear antigen (PCNA) positive cells, fewer macrophages in the MP-rapa and MP-rapa-riva grafts compared to the control PGA graft. The result showed that this scaffold with dual anticoagulation and antiproliferation functions can effectively inhibit venous neointimal hyperplasia, although this is an animal experiment, it showed promising potential clinical application in the future.
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Affiliation(s)
- Peng Sun
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Haoliang Wu
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liwei Zhang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yuanfeng Liu
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Cong Zhang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Chunyang Lou
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Jingan Li
- School of Material Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of materials processing and mold technology (Ministry of Education), Zhengzhou, Henan Province, China
| | - Hualong Bai
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China,Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Zhengzhou, Henan Province, China,CONTACT Hualong Bai ; Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China, 450052
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Yoon YK, Park KH, Park JH, Lee W, Han SH, Lee JW. Long-Term Clinical Outcomes and Implant Survivorship of 151 Total Ankle Arthroplasties Using the HINTEGRA Prosthesis: A Minimum 10-Year Follow-up. J Bone Joint Surg Am 2022; 104:1483-1491. [PMID: 35726878 DOI: 10.2106/jbjs.22.00060] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have investigated long-term clinical outcomes of a mobile-bearing total ankle arthroplasty (TAA) system. This study analyzed long-term outcomes of TAA using the HINTEGRA prosthesis at a single, non-developer center. METHODS Primary TAAs were performed on 213 ankles in 194 patients, and 151 consecutive ankles [71%] in 136 patients with a minimum follow-up of 10 years after the primary TAA were included in this study. Clinical results were assessed using a visual analog scale (VAS) pain score, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale score, the Ankle Osteoarthritis Scale (AOS) pain and disability subscores, and ankle range of motion. Prosthesis survivorship, reoperations, and risk factors were also evaluated. RESULTS The mean follow-up was 135.5 months (range, 120.0 to 204.0 months). All clinical scores and ankle range of motion improved significantly from preoperatively to 2 years, 4 to 6 years, and ≥10 years after TAA (p < 0.001). A total of 43 ankles (28.5%) required revision procedures, with the most common reason being periprosthetic osteolysis (32 ankles [21.2%]). The overall implant survivorship was 93.5% in Kaplan-Meier survival analysis at the mean follow-up of 11.3 years after the TAA. CONCLUSIONS TAA using the HINTEGRA prosthesis with careful follow-up observation and appropriate adjunct procedures for the treatment of end-stage ankle arthritis produced satisfactory clinical results, which were maintained at a follow-up of ≥10 years, and resulted in 93.5% of implant survivorship. LEVEL OF EVIDENCE Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yeo Kwon Yoon
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang Hwan Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Han Park
- Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Wonwoo Lee
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hwan Han
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Xu J, Zhang S, Si H, Zeng Y, Wu Y, Liu Y, Li M, Wu L, Shen B. A genetic correlation scan identifies blood proteins associated with bone mineral density. BMC Musculoskelet Disord 2022; 23:530. [PMID: 35659283 PMCID: PMC9164489 DOI: 10.1186/s12891-022-05453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Osteoporosis is a common metabolic bone disease that is characterized by low bone mass. However, limited efforts have been made to explore the functional relevance of the blood proteome to bone mineral density across different life stages. Methods Using genome-wide association study summary data of the blood proteome and two independent studies of bone mineral density, we conducted a genetic correlation scan of bone mineral density and the blood proteome. Linkage disequilibrium score regression analysis was conducted to assess genetic correlations between each of the 3283 plasma proteins and bone mineral density. Results Linkage disequilibrium score regression identified 18 plasma proteins showing genetic correlation signals with bone mineral density in the TB-BMD cohort, such as MYOM2 (coefficient = 0.3755, P value = 0.0328) among subjects aged 0 ~ 15, POSTN (coefficient = − 0.5694, P value = 0.0192) among subjects aged 30 ~ 45 and PARK7 (coefficient = − 0.3613, P value = 0.0052) among subjects aged over 60. Conclusions Our results identified multiple plasma proteins associated with bone mineral density and provided novel clues for revealing the functional relevance of plasma proteins to bone mineral density. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05453-z.
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Wang J, Xiao L, Wang W, Zhang D, Ma Y, Zhang Y, Wang X. The Auxiliary Role of Heparin in Bone Regeneration and its Application in Bone Substitute Materials. Front Bioeng Biotechnol 2022; 10:837172. [PMID: 35646879 PMCID: PMC9133562 DOI: 10.3389/fbioe.2022.837172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
Bone regeneration in large segmental defects depends on the action of osteoblasts and the ingrowth of new blood vessels. Therefore, it is important to promote the release of osteogenic/angiogenic growth factors. Since the discovery of heparin, its anticoagulant, anti-inflammatory, and anticancer functions have been extensively studied for over a century. Although the application of heparin is widely used in the orthopedic field, its auxiliary effect on bone regeneration is yet to be unveiled. Specifically, approximately one-third of the transforming growth factor (TGF) superfamily is bound to heparin and heparan sulfate, among which TGF-β1, TGF-β2, and bone morphogenetic protein (BMP) are the most common growth factors used. In addition, heparin can also improve the delivery and retention of BMP-2 in vivo promoting the healing of large bone defects at hyper physiological doses. In blood vessel formation, heparin still plays an integral part of fracture healing by cooperating with the platelet-derived growth factor (PDGF). Importantly, since heparin binds to growth factors and release components in nanomaterials, it can significantly facilitate the controlled release and retention of growth factors [such as fibroblast growth factor (FGF), BMP, and PDGF] in vivo. Consequently, the knowledge of scaffolds or delivery systems composed of heparin and different biomaterials (including organic, inorganic, metal, and natural polymers) is vital for material-guided bone regeneration research. This study systematically reviews the structural properties and auxiliary functions of heparin, with an emphasis on bone regeneration and its application in biomaterials under physiological conditions.
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Affiliation(s)
- Jing Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lan Xiao
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
- Australia−China Centre for Tissue Engineering and Regenerative Medicine, Brisbane, Australia
| | - Weiqun Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dingmei Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yaping Ma
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yi Zhang
- Department of Hygiene Toxicology, School of Public Health, Zunyi Medical University, Zunyi, China
| | - Xin Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
- Australia−China Centre for Tissue Engineering and Regenerative Medicine, Brisbane, Australia
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Xie X, Liu Y, Li J, Gu F, Zhang K, Sui Z, Zhang J, Yu T. Fracture risks in patients with atrial fibrillation treated with different oral anticoagulants: a meta-analysis and systematic review. Age Ageing 2022; 51:6514231. [PMID: 35077554 PMCID: PMC8789302 DOI: 10.1093/ageing/afab264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/13/2021] [Indexed: 01/10/2023] Open
Abstract
Aims evidence on the difference in fracture risks for patients with atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs) versus warfarin remains controversial. We aim to compare the fracture risks between the DOAC and warfarin prescriptions among the AF patients. Methods and Results we systematically searched PubMed, EMBASE, the Cochrane Library and Web of Science up to 19 April 2021 for relevant studies. And the observational studies regarding the relationship between the DAOC versus warfarin prescriptions and fracture risks among the patients with AF were included in this meta-analysis. Two investigators independently screened the articles and extracted the relevant data. A random- or fixed-effect model was applied to calculate the pooled hazard ratio/relative ratios with 95% confidence intervals of fracture risks associated with the DOAC and warfarin prescriptions. Six studies comprising 351,208 patients and 9,424 fractures were included in this meta-analysis. Overall, the AF patients treated with DOACs tend to present a lower risk of any fracture compared with those treated with warfarin (relative ratio: 0.82, 95% confidence interval (CI): 0.74–0.91). Sub-analyses for each individual DOAC indicate that apixaban and rivaroxan are associated with lower risk of any fracture compared with warfarin (HR: 0.75, 95% CI: 0.60–0.92, and HR: 0.79, 95% CI: 0.71–0.88, respectively). Conclusion this meta-analysis suggests that DOAC users have a lower risk of fractures than the warfarin users. The results of this study may provide optimal anticoagulation opportunities for AF patients with high fracture risk factors.
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Affiliation(s)
| | | | | | | | | | | | | | - Tiecheng Yu
- Address correspondence to: Tiecheng Yu, Department of Orthopedics, The First Hospital of Jilin University, Changchun, China. Tel: +(0086) 135-9605-8780; E-mail:
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11
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Ostroumova OD, Goloborodova IV. Clinical and Pathophysiological Aspects of the Effect of Anticoagulants on Bone Tissue. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-06-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- O. D. Ostroumova
- Russian Medical Academy of Continuous Professional Education; I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Rocha AL, Bighetti-Trevisan RL, Duffles LF, de Arruda JAA, Taira TM, Assis BRD, Macari S, Diniz IMA, Beloti MM, Rosa AL, Fukada SY, Goulart GAC, Ribeiro DD, Abreu LG, Silva TA. Inhibitory effects of dabigatran etexilate, a direct thrombin inhibitor, on osteoclasts and osteoblasts. Thromb Res 2019; 186:45-53. [PMID: 31883999 DOI: 10.1016/j.thromres.2019.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Anticoagulants are widely used in orthopedic surgery to decrease the risk of deep vein thrombosis. While significant bone impairment is induced by long-term heparin therapy, little is known about the effects of direct oral anticoagulants (DOACs). Herein, we investigated the effects of dabigatran etexilate (Pradaxa®), a DOAC inhibitor of thrombin, on bone cells using in vitro and ex vivo cell culture models. MATERIALS AND METHODS Osteoblasts and osteoclasts exposed to different concentrations of dabigatran etexilate and untreated cells were assayed for cell differentiation and activity. Favorable osteogenic conditions for osteoblasts were tested using titanium with nanotopography (Ti-Nano). In addition, mice treated with a dabigatran etexilate solution had bone marrow cells analyzed for the ability to generate osteoclasts. RESULTS Dabigatran etexilate at concentrations of 1 μg/mL and 2 μg/mL did not impact osteoclast or osteoblast viability. The drug inhibited osteoclast differentiation and activity as observed by the reduction of TRAP+ cells, resorption pits and gene and protein expression of cathepsin K. Consistently, osteoclasts from mice treated with dabigatran showed decreased area, resorptive activity, as well as gene and protein expression of cathepsin K. In osteoblast cultures, grown both on polystyrene and Ti-Nano, dabigatran etexilate reduced alkaline phosphatase (ALP) activity, matrix mineralization, gene expression of ALP and osteocalcin. CONCLUSIONS Dabigatran etexilate inhibited osteoclast differentiation in ex vivo and in vitro models in a dose-dependent manner. Moreover, the drug reduced osteoblast activity even under optimal osteogenic conditions. This study provides new evidence regarding the negative overall impact of DOACs on bone cells.
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Affiliation(s)
- Amanda Leal Rocha
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | | | - Letícia Fernanda Duffles
- Department of Physics and Chemistry, Faculty of Pharmacological Science, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Thaise Mayumi Taira
- Department of Physics and Chemistry, Faculty of Pharmacological Science, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Bruna Rodrigues Dias Assis
- Department of Pharmaceutics, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Soraia Macari
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Ivana Márcia Alves Diniz
- Department of Restorative Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Marcio Mateus Beloti
- Bone Research Laboratory, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Adalberto Luiz Rosa
- Bone Research Laboratory, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Sandra Yasuyo Fukada
- Department of Physics and Chemistry, Faculty of Pharmacological Science, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Gisele Assis Castro Goulart
- Department of Pharmaceutics, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Daniel Dias Ribeiro
- Department of Hematology, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Lucas Guimarães Abreu
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Tarcília Aparecida Silva
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
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Signorelli SS, Scuto S, Marino E, Giusti M, Xourafa A, Gaudio A. Anticoagulants and Osteoporosis. Int J Mol Sci 2019; 20:ijms20215275. [PMID: 31652944 PMCID: PMC6862478 DOI: 10.3390/ijms20215275] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 12/20/2022] Open
Abstract
Anticoagulant agents are widely used in the treatment of thromboembolic events and in stroke prevention. Data about their effects on bone tissue are in some cases limited or inconsistent (oral anti-vitamin K agents), and in others are sufficiently strong (heparins) to suggest caution in their use in subjects at risk of osteoporosis. This review analyses the effects of this group of drugs on bone metabolism, on bone mineral density, and on fragility fractures. A literature search strategy was developed by an experienced team of specialists by consulting the MEDLINE platform, including published papers and reviews updated to March 2019. Literature supports a detrimental effect of heparin on bone, with an increase in fracture rate. Low molecular weight heparins (LMWHs) seem to be safer than heparin. Although anti-vitamin K agents (VKAs) have a significant impact on bone metabolism, and in particular, on osteocalcin, data on bone mineral density (BMD) and fractures are contrasting. To date, the new direct oral anticoagulants (DOACs) are found to safe for bone health.
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Affiliation(s)
| | - Salvatore Scuto
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
| | - Elisa Marino
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
| | - Michele Giusti
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
| | - Anastasia Xourafa
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
| | - Agostino Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
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Ammendola S, Loreto MD, Scotto d'Abusco A. Modulatory Effects of a Nutraceutical Supplement on Saos-2 Cells Reveal Its Phlebotonic Activity. J Am Coll Nutr 2017; 36:268-272. [PMID: 28443720 DOI: 10.1080/07315724.2016.1269622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Herbal extract compositions are largely used to manage vein diseases. We prepared a new composition of herbs, named FLEBO OK™, that, when administered as a nutraceutical to patients affected by peripheral vascular diseases, was able to improve their health conditions. We analyzed the effects of this nutraceutical composition on in vitro cultured cells with the aim to obtain information about its mechanisms of action. METHODS A culture of human osteoblast cell line Saos-2 was stimulated with tumor necrosis factor (TNF)-α or interleukin (IL)-1β to induce the expression of some chemokines and matrix metalloproteases (MMPs). This cell culture was then exposed to the prepared composition and the amount of expression of the genes coding for the monocyte chemotactic protein (MCP)-1, IL-8, IL-1β, MMP-2, MMP-3, MMP-9 proteins was measured by real-time polymerase chain reaction (RT-PCR). The experiments were repeated exposing the cells to the same amount of the well-known micronized purified flavonoid fraction. Moreover, we describe the effects of the administration of nutraceutical composition to 20 patients affected by peripheral vascular diseases and 20 healthy individuals. RESULTS The RT-PCR analyses showed that the new composition induces the expression of MMP-3 and MMP-9 and downregulates MMP-2 in cell cultures stimulated with IL-1β, whereas it induces the expression of IL-8 and represses the expression of IL-1β and MCP-1 in cell cultures stimulated with TNF-α. The induction of the expression of MMP-3 and the downregulation of MCP-1 might result in an antiplatelet activity that was not observed for the micronized purified flavonoid fraction. Interviewed patients reported an improvement in their conditions after 1 month of FLEBO OK treatment. CONCLUSION These findings could provide a hypothesis for the high efficiency of the identified nutraceutical composition to management of peripheral vascular diseases.
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Affiliation(s)
| | | | - Anna Scotto d'Abusco
- c Department of Biochemical Sciences , Sapienza University of Roma , Roma , ITALY
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15
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Somjen D, Sharfman ZT, Katzburg S, Sharon O, Maman E, Salai M, Stern N, Dolkart O. Rivaroxaban significantly inhibits the stimulatory effects of bone-modulating hormones: In vitro study of primary female osteoblasts. Connect Tissue Res 2017; 58:215-220. [PMID: 27661794 DOI: 10.1080/03008207.2016.1220942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Anticoagulant therapy is a mainstay of treatment subsequent to major orthopedic surgeries. Evidence linking anticoagulant therapy, osteoporosis, and delayed fracture healing is not conclusive. We have previously reported that rivaroxaban significantly inhibited cell growth and energy metabolism in a human osteoblastic cell line. This study analyzed the response of primary female osteoblast cells to rivaroxaban in combination with various bone-modulating hormones. METHODS Bone samples were taken from both premenopausal (pre-Ob) and postmenopausal (post-Ob) women. Cells were isolated from each sample and cultured to sub-confluence. Each sample was then treated with Rivaroxaban (10 µg/ml) in combination with the following hormones or with the hormones alone for 24 hours: 30nM estradiol-17β (E2), 390nM estrogen receptor α (ERα) agonist PPT, 420nM estrogen receptor β (ERβ) agonist DPN, 50nM parathyroid hormone (PTH), and 1nM of vitamin D analog JKF. RESULTS No effects were observed after exposure to rivaroxaban alone. When pre-Ob and post-Ob cells were exposed to the bone-modulating hormones as a control experiment, DNA synthesis and creatine kinase (CK)-specific activity was significantly stimulated with a greater response in the pre-Ob cells. When the cells were exposed to rivaroxaban in combination with bone-modulating hormones, the increased DNA synthesis and CK-specific activity previously observed were completely attenuated. CONCLUSIONS Rivaroxaban significantly inhibited the stimulatory effects of bone-modulating hormones in both pre-Ob and post-Ob primary human cell lines. This finding may have clinical relevance for patients at high risk of osteoporosis managed with rivaroxaban or other factor Xa inhibitors.
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Affiliation(s)
- Dalia Somjen
- a Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Zachary T Sharfman
- b Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Sara Katzburg
- a Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Orli Sharon
- a Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Eran Maman
- b Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Moshe Salai
- b Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Naftali Stern
- a Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
| | - Oleg Dolkart
- b Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine , Tel-Aviv University , Tel-Aviv , Israel
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16
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Xia J, Sheng W, Pei L, Li N, Zhang Z, Wang J, Zu J, Wang N, Wang D. Effects of unfractionated heparin and rivaroxaban on the expression of heparanase and fibroblast growth factor 2 in human osteoblasts. Mol Med Rep 2017; 16:361-366. [DOI: 10.3892/mmr.2017.6570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/13/2017] [Indexed: 11/06/2022] Open
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Prodinger PM, Burgkart R, Kreutzer K, Liska F, Pilge H, Schmitt A, Knödler M, Holzapfel BM, Hapfelmeier A, Tischer T, Bissinger O. Does Anticoagulant Medication Alter Fracture-Healing? A Morphological and Biomechanical Evaluation of the Possible Effects of Rivaroxaban and Enoxaparin Using a Rat Closed Fracture Model. PLoS One 2016; 11:e0159669. [PMID: 27455072 PMCID: PMC4959754 DOI: 10.1371/journal.pone.0159669] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/05/2016] [Indexed: 11/25/2022] Open
Abstract
Low molecular weight heparin (LMWH) is routinely used to prevent thromboembolism in orthopaedic surgery, especially in the treatment of fractures or after joint-replacement. Impairment of fracture-healing due to increased bone-desorption, delayed remodelling and lower calcification caused by direct osteoclast stimulation is a well-known side effect of unfractioned heparin. However, the effect of LMWH is unclear and controversial. Recent studies strongly suggest impairment of bone-healing in-vitro and in animal models, characterized by a significant decrease in volume and quality of new-formed callus. Since October 2008, Rivaroxaban (Xarelto) is available for prophylactic use in elective knee- and hip-arthroplasty. Recently, some evidence has been found indicating an in vitro dose independent reduction of osteoblast function after Rivaroxaban treatment. In this study, the possible influence of Rivaroxaban and Enoxaparin on bone-healing in vivo was studied using a standardized, closed rodent fracture-model. 70 male Wistar-rats were randomized to Rivaroxaban, Enoxaparin or control groups. After pinning the right femur, a closed, transverse fracture was produced. 21 days later, the animals were sacrificed and both femora harvested. Analysis was done by biomechanical testing (three-point bending) and micro CT. Both investigated substances showed histomorphometric alterations of the newly formed callus assessed by micro CT analysis. In detail the bone (callus) volume was enhanced (sign. for Rivaroxaban) and the density reduced. The bone mineral content was enhanced accordingly (sign. for Rivaroxaban). Trabecular thickness was reduced (sign. for Rivaroxaban). Furthermore, both drugs showed significant enlarged bone (callus) surface and degree of anisotropy. In contrast, the biomechanical properties of the treated bones were equal to controls. To summarize, the morphological alterations of the fracture-callus did not result in functionally relevant deficits.
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Affiliation(s)
- Peter Michael Prodinger
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675, München, Germany
- * E-mail:
| | - Rainer Burgkart
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675, München, Germany
| | - Kilian Kreutzer
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Franz Liska
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675, München, Germany
| | - Hakan Pilge
- Orthopädische Klinik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstraße 5, D-40225, Düsseldorf, Germany
| | - Andreas Schmitt
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Abteilung für Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, D-81675, München, Germany
| | - Martina Knödler
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675, München, Germany
| | - Boris Michael Holzapfel
- Regenerative Medicine Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Alexander Hapfelmeier
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675, München, Germany
| | - Thomas Tischer
- Orthopädische Klinik und Poliklinik, Universität Rostock, Doberaner Straße 142, D-18057, Rostock, Germany
| | - Oliver Bissinger
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Germany
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Pilge H, Fröbel J, Prodinger PM, Mrotzek SJ, Fischer JC, Zilkens C, Bittersohl B, Krauspe R. Enoxaparin and rivaroxaban have different effects on human mesenchymal stromal cells in the early stages of bone healing. Bone Joint Res 2016; 5:95-100. [PMID: 26989119 PMCID: PMC4852789 DOI: 10.1302/2046-3758.53.2000595] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives Venous thromboembolism (VTE) is a major potential complication following orthopaedic surgery. Subcutaneously administered enoxaparin has been used as the benchmark to reduce the incidence of VTE. However, concerns have been raised regarding the long-term administration of enoxaparin and its possible negative effects on bone healing and bone density with an increase of the risk of osteoporotic fractures. New oral anticoagulants such as rivaroxaban have recently been introduced, however, there is a lack of information regarding how these drugs affect bone metabolism and post-operative bone healing. Methods We measured the migration and proliferation capacity of mesenchymal stem cells (MSCs) under enoxaparin or rivaroxaban treatment for three consecutive weeks, and evaluated effects on MSC mRNA expression of markers for stress and osteogenic differentiation. Results We demonstrate that enoxaparin, but not rivaroxaban, increases the migration potential of MSCs and increases their cell count in line with elevated mRNA expression of C-X-C chemokine receptor type 4 (CXCR4), tumor necrosis factor alpha (TNFα), and alpha-B-crystallin (CryaB). However, a decrease in early osteogenic markers (insulin-like growth factors 1 and 2 (IGF1, IGF2), bone morphogenetic protein2 (BMP2)) indicated inhibitory effects on MSC differentiation into osteoblasts caused by enoxaparin, but not by rivaroxaban. Conclusions Our findings may explain the adverse effects of enoxaparin treatment on bone healing. Rivaroxaban has no significant impact on MSC metabolism or capacity for osteogenic differentiation in vitro. Cite this article: Dr H. Pilge. Enoxaparin and rivaroxaban have different effects on human mesenchymal stromal cells in the early stages of bone healing. Bone Joint Res 2016;5:95–100. DOI: 10.1302/2046-3758.53.2000595.
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Affiliation(s)
- H Pilge
- Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - J Fröbel
- Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - P M Prodinger
- Clinic for Orthopedics and Sports Orthopedics, Technical University of Munich, 81675 Munich, Germany
| | - S J Mrotzek
- Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - J C Fischer
- Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - C Zilkens
- Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - B Bittersohl
- Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - R Krauspe
- Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany
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Pilge H, Fröbel J, Mrotzek SJ, Fischer JC, Prodinger PM, Zilkens C, Bittersohl B, Krauspe R. Effects of thromboprophylaxis on mesenchymal stromal cells during osteogenic differentiation: an in-vitro study comparing enoxaparin with rivaroxaban. BMC Musculoskelet Disord 2016; 17:108. [PMID: 26927834 PMCID: PMC4772441 DOI: 10.1186/s12891-016-0966-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/24/2016] [Indexed: 01/08/2023] Open
Abstract
Background Low-molecular-weight heparins (e.g. Enoxaparin) are widely used to prevent venous thromboembolism after orthopaedic surgery, but there are reports about serious side effects including reduction in bone density and strength. In recent years new oral antithrombotic drugs (e.g. direct Factor Xa-inhibitor, Rivaroxaban) have been used to prevent venous thromboembolism. However, there is lack of information on the effects of these new drugs on human mesenchymal stromal cells during osteogenic differentiation and, therefore, effects during postoperative bone healing. Methods We evaluated the effects of Rivaroxaban and Enoxaparin on the proliferation, mRNA and surface receptor expression as well as differentiation capacity of primary human mesenchymal stromal cells during their osteogenic differentiation. Results Enoxaparin, but not Rivaroxaban treatment significantly increased human mesenchymal stromal cell (hMSC) proliferation during the first week of osteogenic differentiation while suppressing osteogenic marker genes, surface receptor expression and calcification. Conclusions This is the first paper to demonstrate that Rivaroxaban had no significant influence on hMSC differentiation towards the osteogenic lineage, indicating a less affected bone healing process compared with Enoxaparin in vitro. Based on these findings Rivaroxaban seems to be superior to Enoxaparin in early stages of bone healing in vitro. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-0966-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hakan Pilge
- Department of Orthopaedic Surgery, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Julia Fröbel
- Department of Orthopaedic Surgery, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Silvia J Mrotzek
- Department of Orthopaedic Surgery, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Johannes C Fischer
- Institute for Transplantation Diagnostics and Cell Therapeutics, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Peter M Prodinger
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Christoph Zilkens
- Department of Orthopaedic Surgery, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Bernd Bittersohl
- Department of Orthopaedic Surgery, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Rüdiger Krauspe
- Department of Orthopaedic Surgery, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
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Xia J, Zhang Z, Wang J, Zu J, Wang N, Wang D. Comparison of the effects of heparin and the direct factor Xa inhibitor, rivaroxaban, on bone microstructure and metabolism in adult rats. Connect Tissue Res 2015; 56:477-82. [PMID: 26305919 DOI: 10.3109/03008207.2015.1069285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM Deep venous thrombosis is a significant complication following surgery, and is associated with high morbidity and mortality in adults. The direct factor Xa inhibitor, rivaroxaban, is used to prevent venous thromboembolism in patients suffering from trauma and joint arthroplasty. The present study compared the effects of rivaroxaban and heparin on bone microstructure and metabolism in adult rats. MATERIALS AND METHODS Twenty-four Wistar rats were divided into sham, rivaroxaban and heparin groups. Rivaroxaban (1.5 mg·kg(-1)·d(-1)) and heparin (2 IU·g(-1)·d(-1)) were administered for 4 weeks. To assess changes in bone metabolism, serum calcium and phosphorus levels, and bone formation and resorption markers were examined. Micro-CT analysis was used to examine the microstructure of both trabecular and cortical bone. Dual energy X-ray absorptiometry was employed to detect bone mineral density (BMD). RESULTS Serum phosphorus levels were significantly lower in both rivaroxaban (1.33 ± 0.07 mmol/L) and heparin (1.33 ± 0.21 mmol/L) rats than in sham rats (1.71 ± 0.14 mmol/L). Activity and levels of bone formation markers, bone-specific alkaline phosphatase (BAP) and type I procollagen N-terminal pro-peptide (PINP), were 32.4 and 38.2% lower in heparin-treated rats than in sham rats. Bone resorption markers, pyridinoline (PYD) and deoxypyridinoline (DPD), were 20.1 and 34.3% higher in heparin-treated rats than in sham rats, respectively. By contrast, rivaroxaban only resulted in a decrease PINP levels. Bone volume fraction (BV/TV) decreased by 23.5 and 20.5% from those in sham rats, while trabecular separation (Tb.Sp) increased by 28.2 and 16.3% in trabecular bone of heparin- and rivaroxaban-treated rats, [corrected] respectively. Moreover, the microstructure of cortical bone and BMD were negatively affected by heparin but not by rivaroxaban. CONCLUSION Rivaroxaban leads to fewer adverse effects on bone microstructure than heparin.
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Affiliation(s)
- Jingjun Xia
- a Department of Orthopaedics , The Second Affiliated Hospital of Harbin Medical University , Harbin , People's Republic of China
| | - Zhipeng Zhang
- a Department of Orthopaedics , The Second Affiliated Hospital of Harbin Medical University , Harbin , People's Republic of China
| | - Jialiang Wang
- a Department of Orthopaedics , The Second Affiliated Hospital of Harbin Medical University , Harbin , People's Republic of China
| | - Jianing Zu
- a Department of Orthopaedics , The Second Affiliated Hospital of Harbin Medical University , Harbin , People's Republic of China
| | - Nanxiang Wang
- a Department of Orthopaedics , The Second Affiliated Hospital of Harbin Medical University , Harbin , People's Republic of China
| | - Duanyang Wang
- a Department of Orthopaedics , The Second Affiliated Hospital of Harbin Medical University , Harbin , People's Republic of China
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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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