Thromboprophylaxis Using a Low Molecular Weight Heparin Delays Fracture Repair

Street, John; McGrath, Martina; O’Regan, Kevin; Wakai, Abel; McGuinness, A.; Redmond, H. P.

doi:10.1097/00003086-200012000-00032

Cited by 66 publications

(69 citation statements)

References 15 publications

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“…LMWHs are replacing heparins for many indications in Europe and for limited indications in North America 1 .…”

Section: Discussionmentioning

confidence: 99%

“…Deep vein thrombosis occurs in 50% to 70% of patients undergoing major lower limb orthopedics surgery, in patients with acute spinal injury or multiple traumas without prophylaxis 1 . After almost three decades of intensive research, low-molecularweight heparins (LMWH) have established their niche as an important class of antithrombotic compounds.…”

Section: Introductionmentioning

confidence: 99%

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The effect of prophylactic dose of a low molecular weight heparin on skin wound healing of rats

et al. 2009

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Purpose:To investigate the effect of prophylactic dose of a low molecular weight heparin, enoxaparin, on skin wound healing of rats. Methods: Forty rats were used for the study. Rats were randomly assigned to two equal groups. Experimental group received prophylactic dose of enoxaparin. Physiologic saline was administered to the control group. Parameters of wound healing of experimental and control groups were compared. For comparison of the groups in terms of fibrosis, vascularization, inflammation, epithelization, and tensile strength test (Newton). Mann-Whitney-U test was used because variables were categorical data (fibrosis, vascularization, inflammation and epithelization). Differences between groups were analyzed with independent samples t-test (tensile strength). Significance was set at p<0.05. Results: Skin wound of the experimental group presented tensile strength significantly decreased (p<0.001), histopathologic examination revealed a significant (p<0.001) delayed epithelization and decreased in fibrosis, vascularization, inflammation (p<0.001) in the experimental group. Conclusion: Enoxaparin delay wound healing by decreased inflammatory cells, fibroblast contents and their products (growth factors), and by promoted hemorrhage.

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“…LMWHs are replacing heparins for many indications in Europe and for limited indications in North America 1 .…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect of prophylactic dose of a low molecular weight heparin on skin wound healing of rats

et al. 2009

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“…At the beginning of this study, we thought that heparin and the enoxaparin would affect fracture healing negatively but fondaparinux that has positive effects on osteoblasts according to the previous papers would effect positively on fracture healing (6)(7)(8)(9)(10)(11)(12). Hereby, fondaparinux would be used in traumatic patients with fractures safely as an antiembolic agent was a part of our hypothesis.…”

Section: Discussionmentioning

confidence: 88%

Fondapari̇nuksun Kirik İyi̇leşmesi̇ne Gerçekten Pozi̇ti̇f Etki̇si̇ Var Midir? Siçanlar Üzeri̇nde Yapilan Deneysel Bi̇r Çalişma

Mercan¹,

Aydın²,

Konya³

et al. 2017

Kocatepe Tıp Dergisi

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Antiembolik ajanlar ortopedi ve travmatoloji kliniklerinde özellikle artroplasti, tümör ve travma cerrahilerinde embolizm problemlerini azaltmak için rutin olarak kullanılmaktadır. Fondaparinuks'un kırık iyileşmesi üzerine etkisi belirsizdir. Bu çalışmanın amacı sıçan modeli kullanarak fondaparinuksun kırık iyileşmesi üzerine etkisinin incelenmesi ve enoksaparinin etkisi ile karşılaştırılmasıdır.GEREÇ VE YÖNTEM: 64 adet Wistar-Albino sekiz gruba randomize olarak ayrıldı. Genel anestezi altında sol femur kapalı standart kırıkları oluşturuldu. Kontrol grupları (A, B), heparin grupları (C, D), enoksaparin grupları (E, F), ve fondaparinuks grupları (G, H), sırasıyla izotonik NaCl (1cc/gün), heparin (1000 anti Xa IU/kg/gün), enoksaparin (100 anti Xa IU/kg/gün) ve fondaparinuks (0.2mg/kg/ gün) olacak şekilde 14 gün süre ile uygulandı. A, C, E, G gruplarındaki sıçanlar postoperatif 14. günün, B, D, F, H gruplarındakiler ise 28. günün sonunda sakrifiye edildiler. Tüm femurların radyolojik incelemesi standart ön-arka ve yan grafiler kullanılarak Goldberg sınıflamasına göre yapıldı. Histolojik inceleme ise Huo histolojik iyileşme sınıflamasına göre yapıldı. Bu çalışmanın istatiksel analizleri GraphPad Prisma V.3 paket programı kullanılarak yapıldı. Sonuçlarda anlamlılık p<0.05 düzeyi olarak belirlendi. BULGULAR: Radyolojik incelemede, ikinci ve dördüncü hafta sonundaki sonuçlar incelendiğinde, gruplar arasında istatiksel olarak anlamlı fark saptanmadı. Histolojik incelemede ise heparin almış olan H grubundaki iyileşme sonuçları diğer gruplarla karşılaştırıldığında istatiksel olarak anlamlı şekilde kötü olarak saptandı. Diğer gruplar arasında histolojik açıdan, heparin grubu hariç, istatiksel olarak anlamlı bir fark saptanmadı. Ayrıca histolojik ve radyolojik olarak fondaparinuks ve enoksaparin grupları arasında kırık iyileşmesi üzerine etkileri arasında istatiksel olarak anlamlı fark saptanmadı (p>0.05). SONUÇ:Çalışmamızda fondaparinuksun enoksaparin ile karşılaştırıldığında kırık iyileşmesi üzerine herhangi ekstra olumlu etkisini saptamadık. Fondaparinuks uygulamasının kırık iyileşmesi üzerine negatif bir etkisi saptanmamış olması nedeniyle travma vakalarında embolizm problemlerini önlemede kullanılabileceği kanaatindeyiz.

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“…At the 7 th POD, a higher breaking strength was observed for the study group in relation to the control one (p=0.01). This fact could be explained by a better angiogenesis of rats treated with enoxaparin, once heparin is associated with the activation of fibroblasts growth factors, epidermal growth and especially vascular endothelial growth 10,11,12,13 . This latter would be the main factor for the vascular neoformation stimulus 13,14,15,16 .…”

Section: Discussionmentioning

confidence: 99%

“…This heparin presents high capacity to inhibit the Xa factor, weak anti-IIa or anti-thrombin activity, lower affinity for plasmatic and vascular proteins, endothelial cells, macrophages and platelets, granting higher availability and plasmatic half-life and reduction on the side effects associated with thrombocytopeny and risk of bleeding when compared to non-fractioned heparins 6,7,8 . Besides its anticoagulant action, heparin presents several biological activities such as antiinflammatory action, immunological modulation and activation of vascular endothelial growth factors, fibroblasts growth factors and epidermal growth associated to heparin, all vital for healing 10,11,12,13 . Heparin also regulates angiogenesis and presents a chemotactic effect for endothelial cells in human cells cultures by enhancing the growth factor activity resulting in stimulus to vascular neoformation 13,14,15,16 .…”

Section: Introductionmentioning

confidence: 99%

Effects of enoxaparin on the healing of abdominal wall in rats: study on breaking strength and histopatology

et al. 2006

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Purpose:To evaluate the influence of enoxaparin on the abdominal wall healing. Methods: Sixty Wistar male rats were randomly distributed into two experimental groups. Group E: consisted of 30 rats, submitted to abdominal suture and treated with enoxaparin in a dose of 1 mg/kg of body weight, subcutaneously administered from immediate postoperative until the 7 th day; Group C: consisted of 30 rats submitted to abdominal suture and treated with the equivalent dose per volume of NaCl 0.9%. The animals were submitted to median laparotomy and were operated again at the 3 rd , 7 th or 14 th postoperative day for the resection of the anterior abdominal wall. The tissue's stretching resistance was tested and a histopathological evaluation was performed. Through Mann-Whitney's U test, a statistical analysis was conducted considering significant values for p <0.05. Results: The tensile breaking strength presented a median of 0.64N for group C and 0.41N for group E (p=0.60) at the 3 rd postoperative day; of 2.27N for group C and of 4.32N for group E (p=0.01) at the 7 th POD; of 5.72N for group C and of 6.62N for group E (p=0.97) at the 14 th POD. In relation to the histopathological study, the results did not show significant statistical differences, except for the amount of collagen at the 7 th POD, which medians were 2 on group C and 1 on group E (p=0.007). Conclusion: Considering the conditions in which this study was conducted, the administration of enoxaparin led to an strengthening of the tissue's breaking resistance at the 7 th POD; on the histopathological exam, a significant difference was observed at the 7 th POD, with a better collagen disposition on group C. Key words: Heparin, Low-Molecular-Weight. Enoxaparin. Anticoagulants. Abdominal Wall. Wound Healing. Rats. RESUMOObjetivo: Avaliar a influência da enoxaparina, sobre a cicatrização da parede abdominal. Métodos: Foram utilizados 60 ratos Wistar, distribuídos aleatoriamente em grupo estudo (E) e controle (C). O grupo E recebeu 1 mg/kg de enoxaparina, via subcutânea, do pós-operatório imediato até o 7º dia pós-operatório (DPO); o grupo C doses-volume equivalentes de NaCl 0,9%. Os animais foram submetidos à laparotomia mediana e reoperados no 3º, 7º ou 14º DPO, para ressecção da parede abdominal anterior. A resistência tênsil foi testada e feita avaliação histopatológica. Análise estatística realizada com o teste U de Mann-Whitney, considerando significantes valores de p<0,05. Resultados: A força tênsil de ruptura apresentou mediana de 0,64N para grupo C e de 0,41N para grupo E (p=0,60) no 3º DPO; de 2,27N para grupo C e de 4,32N para grupo E (p=0,01) no 7º DPO; de 5,72N para grupo C e de 6,62N para grupo E (p=0,97) no 14º DPO. Quanto ao estudo histopatológico, os resultados não obtiveram diferenças estatísticas significantes, exceto pela disposição do colágeno no 7º DPO, cujas medianas foram 2 no grupo C e 1 no grupo E (p= 0,007). Conclusão: Nas condições em que foi realizado o presente estudo, a enoxaparina provocou aumento da força tênsil de ruptura...

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Thromboprophylaxis Using a Low Molecular Weight Heparin Delays Fracture Repair

Cited by 66 publications

References 15 publications

The effect of prophylactic dose of a low molecular weight heparin on skin wound healing of rats

The effect of prophylactic dose of a low molecular weight heparin on skin wound healing of rats

Fondapari̇nuksun Kirik İyi̇leşmesi̇ne Gerçekten Pozi̇ti̇f Etki̇si̇ Var Midir? Siçanlar Üzeri̇nde Yapilan Deneysel Bi̇r Çalişma

Effects of enoxaparin on the healing of abdominal wall in rats: study on breaking strength and histopatology

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