title: Rivaroxaban does not impair fracture healing in a rat femur fracture model: an experimental study.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany. tim.klueter@uksh.de.
authors.forename: Tim
authors.initials: T
authors.lastname: Klüter
authors.affiliation: Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany. matthias.weuster@uksh.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Weuster
authors.affiliation: Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany. schreibstefan@gmx.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Brüggemann
authors.affiliation: Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany. leif.menzdorf@uksh.de.
authors.forename: Leif
authors.initials: L
authors.lastname: Menzdorf
authors.affiliation: Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany. stefanie.oestern@uksh-kiel.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Fitschen-Oestern
authors.affiliation: Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany. nadine.steubesand@uksh.de.
authors.forename: Nadine
authors.initials: N
authors.lastname: Steubesand
authors.affiliation: Department of Maxillo-Facialy, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany. acil@mkg.uni-kiel.de.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Acil
authors.affiliation: Department of Anatomy and Cell Biology, RWTH Aachen University, Aachen, Germany. tpufe@ukaachen.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pufe
authors.affiliation: Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany. deike.varoga@uksh-kiel.de.
authors.forename: Deike
authors.initials: D
authors.lastname: Varoga
authors.affiliation: Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany. andreas.seekamp@uksh-kiel.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Seekamp
authors.affiliation: Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany. sebastian.lippross@uksh.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lippross
mesh_terms: D000818:Animals; D000925:Anticoagulants / Q000494:pharmacology* / Q000627:therapeutic use*; D001696:Biomechanical Phenomena / Q000502:physiology; D015519:Bone Density / Q000502:physiology; D005260:Female; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D005269:Femur / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing / Q000187:drug effects* / Q000502:physiology; D023421:Models, Animal; D051381:Rats; D017208:Rats, Wistar; D000069552:Rivaroxaban / Q000494:pharmacology* / Q000627:therapeutic use*; D013927:Thrombosis / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000069552:Rivaroxaban