Postoperative aspirin use and its effect on bone healing in the treatment of ankle fractures

Hunter, Allison M.; Montgomery, Tyler; Pitts, Charles; Moraes, Leonardo; Anderson, Matthew; Wilson, John T.; McGwin, Gerald; Shah, Ashish

doi:10.1016/j.injury.2019.11.039

Cited by 12 publications

(15 citation statements)

References 22 publications

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“…The use of antiaggregant ASA (75-325 mg/d) was not found to have a negative effect on bone healing. Similarly, Hunter et al (18) found no difference observed between bone healing of ankle fractures in the 6-month follow-up of patients using ASA postoperatively to treat their pain.…”

Section: Discussionmentioning

confidence: 94%

The effects of dual anti-platelet therapy on titanium implant osseointegration: an experimental study

Kobat

Dündar

Bozoğlan

et al. 2022

Journal of Health Sciences and Medicine

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Aim: In this study, we aim to investigate the effect of dual anti-platelet agents on osseointegration by studying a sample of rats with titanium implants in their tibias. Material and Method:The titanium implants were placed surgically to the left tibias of a sample group of 50 rats. After implantation, the rats were randomly divided into five groups: acetylsalicylic acid (ASA) (n =10), treated with 20 mg/kg of ASA; ASA+ clopidogrel (CLPD) (n=10), treated with 20 mg/kg of ASA and 30 mg/kg of CLPD; ASA+ prasugrel (PRSG) (n=10), treated with 20 mg/kg of ASA and 15 mg/kg of PRSG; ASA+ ticagrelor (TCGR) (n=10), treated with 20 mg/kg of ASA and 300 mg/kg of TCGR; and a control group (CNT) (n =10) received no further treatment following implant surgery. The experimental period lasted four weeks, during which all medications were administered with oral gavage. Concluding the experimental period, the animals were euthanized, and researchers collected blood serums and the implants, along with some surrounding bones, from each rats. Results: Bone implant connection and bone filling ratios (%) were observed histologically and documented. The bone-implant connection and bone filling ratios of the rats do not show statistically significant differences between the groups examined (P>0.05). Conclusion:In this study, it was shown that there was no bone healing problem between the antiaggregant given groups and between these groups and the control group. Too many people have to take single or double antiaggregant due to many diseases. We think that it is an important study in terms of knowing that bone healing will not be negatively affected when dental implants or other bone prosthesis procedures are applied to these patients. The results of this study should be supported by further research.

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Section: Discussionmentioning

confidence: 94%

The effects of dual anti-platelet therapy on titanium implant osseointegration: an experimental study

Kobat

Dündar

Bozoğlan

et al. 2022

Journal of Health Sciences and Medicine

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“…Bauer et al 29 consistently found that aspirin use was associated with 2–3–5.8% increase in bone mineral density at hip and spine among older women. There was, however, neither protective (Bauer et al 29 ) nor healing effect on bone fracture (Hunter et al 30 ). In addition, the role of aspirin on bone mineral density is believed to be dose dependent.…”

Section: Discussionmentioning

confidence: 99%

NHANES cross sectional study of aspirin and fractures in the elderly

Swed

El-Sakka

Abouainain

et al. 2023

Sci Rep

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Bone fractures are a global public health concern, yet no thorough investigation of low-dose aspirin usage to prevent fractures in the elderly has been conducted. Many interventional human and animal studies have tried to detect the correct role of low-dose aspirin on fractures in elderly persons. The literature doesn't consist of a retrospective observational study that includes a large number of older individuals and evaluates the accurate effect of aspirin on the fractures post falling from low heights. This cross-sectional includes 7132 elderly persons and aimed to detect if there was a link between taking low-dose aspirin to prevent fractures in the elderly. Data was extracted from the National Health and Nutrition Examination Survey (NHANES) database for 2017–2020 and 2013–2014. Demographic and examination data were collected during in-home interviews and study visits to a mobile examination center. Standardized questionnaires were used to collect information such as age, gender, race, educational level, and family income-to-poverty ratio. Body mass index (BMI), weight, standing height, upper leg length, upper arm length, arm circumference, and wrist circumference were all measured during the examination. The study examined 8127 patients, with 7132 elderly patients suitable for data analysis. The odds ratio of fractures due to a fall from standing height or less was 0.963 (95 percent confidence interval 0.08–1.149) in low-dose aspirin users, while having parents with osteoporosis had a related risk of 1.23. (95 percent confidence interval 0.81–1.8). The total number of fractures was 1295; with hip fractures constituting up to 13.82%, wrist fractures of 66.56%, and spine fractures of 19.61%. There was no significant difference in femur and spine bone mineral density (BMD) in the two groups (use low dose aspirin and don't use). Females had a 5.6 times greater fracture risk related to a fall from standing height or less (1 time or more) than males (P-value < 0.001). Furthermore, taking aspirin had no effect on the occurrence of fractures from standing height or less in older people (P-value = 0.468). In addition, the logistic regression after performing the propensity matching score confirmed that there was no impact of taking aspirin on the occurrence of fractures (P-value > 0.05). This cross-sectional study reveals that taking low-dose aspirin to prevent fractures in the elderly is statistically insignificant. However, fractures are more common in older persons, especially in older women; thus, more widespread injury prevention initiatives and access to osteoporosis prevention and diagnosis for older people should improve to minimize the overall burden.

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“…difference in symptomatic VTE rates between aspirin and no treatment. [42] Stronger evidence regarding aspirin is likely forthcoming in 2 ongoing trials: PREVENTion of Clot in Orthopaedic Trauma (NCT02984384), and A Different Approach to Preventing Thrombosis (NCT02774265).…”

Section: Discussionmentioning

confidence: 99%

“…[ 38 ] A retrospective study showed aspirin does not impair union rates in ankle fractures, though this same study secondarily found no statistically significant difference in symptomatic VTE rates between aspirin and no treatment. [ 42 ] Stronger evidence regarding aspirin is likely forthcoming in 2 ongoing trials: PREVENTion of Clot in Orthopaedic Trauma (NCT02984384), and A Different Approach to Preventing Thrombosis (NCT02774265).…”

Section: Discussionmentioning

confidence: 99%

Qualitative analysis of randomized controlled trials informing recommendations for venous thromboembolism prophylaxis after distal lower extremity injuries

Folsom

Polmear

Dunn

et al. 2022

OTA International: The Open Access Journal of Orthopaedic Trauma

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The purpose of this study is to assess the quality of evidence to stratify recommendations for chemoprophylaxis following distal lower extremity trauma.Methods: Literature review identified primary studies investigating venous thromboembolism (VTE) chemoprophylaxis following traumatic injury distal to the knee. Inclusion criteria were randomized controlled trials in adult patients treated with and without operative intervention. Each primary study was assessed by the Consolidated Standards of Reporting Trials 2010 checklist and Modified Coleman methodology score.Results: Literature review resulted in 462 studies, of which 9 met inclusion and exclusion criteria. All studies included low molecular weight heparin as a treatment group with 2 (22%) also including a treatment group with a direct factor Xa inhibitor. Five studies (56%) used placebo as a control group. The mean Modified Coleman Methodology score was 63% (range 51%-72%), a categorical rating of Fair. The mean Consolidated Standards of Reporting Trials score was 78% (range 56%-97%). Most studies (89%) screened all asymptomatic subjects for deep venous thrombosis. Statistical significance in VTE incidence among prophylactic treatment groups was not achieved in 78%.Conclusions: Development of consensus for VTE prophylaxis recommendations following traumatic injury distal to the knee is complicated by heterogenous study populations, low incidence of VTE in study populations, and inconsistent definitions of clinically important VTE. Low molecular weight heparin is not consistently superior for preventing VTE. Chemoprophylaxis should be considered on an individual basis in the presence of additional risk factors, although an externally validated, evidence-based risk assessment tool does not currently exist.Level of Evidence: IV, therapeutic

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Postoperative aspirin use and its effect on bone healing in the treatment of ankle fractures

Cited by 12 publications

References 22 publications

The effects of dual anti-platelet therapy on titanium implant osseointegration: an experimental study

The effects of dual anti-platelet therapy on titanium implant osseointegration: an experimental study

NHANES cross sectional study of aspirin and fractures in the elderly

Qualitative analysis of randomized controlled trials informing recommendations for venous thromboembolism prophylaxis after distal lower extremity injuries

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