title: The effect of anticoagulant pharmacotherapy on fracture healing.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Trauma and Orthopaedics University of Leeds, School of Medicine, Academic Department of Trauma and Orthopaedics, Clarendon Wing A, Leeds General Infirmary Teaching Hospital NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
authors.forename: Tobias
authors.initials: T
authors.lastname: Lindner
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cockbain
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: El Masry
authors.forename: Paul
authors.initials: P
authors.lastname: Katonis
authors.forename: Evgenios
authors.initials: E
authors.lastname: Tsiridis
authors.forename: Constantin
authors.initials: C
authors.lastname: Schizas
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Tsiridis
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects; D016723:Bone Remodeling / Q000187:drug effects; D001842:Bone and Bones / Q000166:cytology / Q000187:drug effects* / Q000378:metabolism; D004195:Disease Models, Animal; D000077425:Fondaparinux; D017102:Fracture Healing / Q000187:drug effects*; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D011134:Polysaccharides / Q000009:adverse effects; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D011134:Polysaccharides; D014859:Warfarin; D006493:Heparin; D000077425:Fondaparinux; D001241:Aspirin