The effect of anticoagulant pharmacotherapy on fracture healing

Expert Opinion on Pharmacotherapy
Tobias LindnerEleftherios Tsiridis

Abstract

There is in vitro and in vivo evidence that anticoagulants impair normal bone metabolism, and it is widely believed that this may impair fracture healing. However, there are only a few heterogeneous in vivo animal studies confirming this and the mechanisms are not fully understood. To review the literature concerning the effects of anticoagulants on fracture healing, and to present current understanding of the mechanisms involved by reviewing in vivo studies of bone biology and in vitro studies of bone cells. A systematic search of Medline and other databases was combined with manual searching of bibliographies of key papers to identify relevant studies in the English and German languages. There is strong evidence that warfarin, heparin and aspirin retard fracture healing. The preferential use of low molecular weight heparins is advocated to minimise this. Fondaparinux has not shown any impairment in vitro. Further studies of fondaparinux, the timing of anticoagulation therapy and the mechanisms of action of these agents are of paramount importance.

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Citations

Jan 22, 2013·Thrombosis Research·Ferhat SayMehmet Gönültaş
Mar 31, 2015·Journal of the American Podiatric Medical Association·Robert G Smith
Jul 13, 2016·Journal of Tissue Engineering and Regenerative Medicine·Xin WangYin Xiao
Aug 16, 2019·Zeitschrift für Gerontologie und Geriatrie·G DadwalG Kolb
Sep 28, 2020·Current Medical Science·Hai-Feng HangYou-Jia Xu

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