COMPARISON OF RIVAROXABAN AND DIFFERENT ANTICOAGULANTS ON BONE UNION IN A RAT MODEL

Yıl 2016, Cilt: 2 Sayı: 3, 310 - 322, 15.12.2016

Muhammet Zeki Gültekin , Ender Alagöz , Serdar Yüksel , Şule Özsoy Ali Avcı , Mehmet Akif Güleç Oğuz Uğur

https://doi.org/10.30569/adiyamansaglik.438883

Öz

Objective:
Thromboembolic complications due to
immobilization in the treatment of lower extremity fractures are the leading
problems in treatment. This
study was undertaken to examine the effect of a number of different
anti-embolic agents, i.e. enoxaparin, fondaparinux, and rivaroxaban, on bone
healing in an experimental rat model.

 

Methods: In
our study, 60 rats of the same number of Sprague-Dawley rats were divided into
4 groups. Group 1 received 1 cc saline
solution subcutaneously, group 2 fondaparinux 1 mg / kg subcutaneously, group 3
rivaroxaban 3 mg / kg oral gavage and group 4 enoxaparin 100 anti Xa IU / kg
subcutaneously once daily for 2 weeks.All groups were sacrificed at 4 weeks and
biochemical, radiographic and histopathologic evaluations of fractured calluses
in acute and subacute periods were evaluated.

 

Results: A high inter-rater agreement was found for
clinical assessments for the presence of pathological macroscopic mobility in
the fracture line. Complete fusion was significantly lower among rats in Group
4 as compared to Groups, 1, 2, and 3. Group 2 had complete fusion. Radiological
assessment scores in Group 1 were significantly lower as compared to those in
Groups 2 and 3 . Also, Group 4 had significantly lower radiological scores than
Group 2. Histopathological
assessments showed no statistically significant differences between the study
groups, although scores in Groups 2 and 3 were numerically higher.

 

Conclusion: In
this study,  enoxaparin, rivaroxaban, and
fondaparinux, demonstrated no adverse impacts on bone healing. Rivaroxaban may
represent a viable alternative to other anti-thrombotic agents owing to its
oral administration, no requirement for therapeutic monitoring, and better
patient tolerability.  

Anahtar Kelimeler

Fracture Healing, Rivaroxaban, Enoxaparin, fondaparinux, rats

RİVAROKSABAN VE FARKLI ANTİKOAGÜLANLARIN KIRIK KAYNAMASI ÜZERİNE ETKİLERİNİN BİR RAT MODELİNDE KARŞILAŞTIRILMASI

Öz

Amaç: Alt ekstremite kırıklarının tedavisinde immobilizasyona bağlı
tromboembolik olayları önlemek için antikoagulan profiklasisi kullanmak
gerekmektedir.  Biz bu çalışmada;
deneysel bir sıçan kırık modelinde, faktör Xa’nın seçici olarak inhibisyon
yapan  rivaroksabanın ile kırık iyileşme
süreci üzerine etkilerini,enoksaparin ve fondaparinuks ile kıyaslamayı
amaçladık.

Yöntem: Çalışmamızda 60 adet Sprague
-Dawley cinsi eşit sayıda rat 4 guruba ayrıldı ve

Grup 1’e (kontrol grubu) 1
cc salin solüsyonu subkutan, grup 2’ye fondaparinuks 1 mg/kg dozunda subkutan, grup 3’e
rivaroksaban 3 mg/kg dozunda oral gavaj yoluyla ve grup 4’e enoxaparin 100 anti Xa IU/kg dozunda subkutan olarak, 2 hafta
boyunca günde tek doz uygulandı. Tüm gruplar 4. haftada sakrifiye edilerek kırık kallusları akut
ve subakut dönemlerde biyomekanik, radyografik ve histopatolojik olarak
değerlendirildi.

Bulgular: Makroskopik patolojik hareket varlığı
incelendiğinde, gözlemciler arasındaki uyum istatistiksel olarak anlamlı
bulundu. Grup 4’ün tam füzyon istatistiksel olarak anlamlı derecede düşük
bulundu ve grup 2’deki tüm sıçanlarda tam füzyon gözlendi.  Radyolojik incelemede; Grup 1’in radyolojik
değerlendirme skorları grup 2 ve grup 3’den istatistiksel olarak anlamlı
derecede düşük bulundu, grup 4’ün radyolojik değerlendirme skorları grup 2’den
istatistiksel olarak anlamlı derecede düşük bulundu.Histopatolojik sonuçlar değerlendirildiğinde,
grup 2 ve grup 3’te skorlar daha yüksek olsa da, tüm
grupların histopatolojik skorları arasında istatistiksel olarak anlamlı farklılık
gözlenmedi.

Sonuç: Çalışmamızda enoksaparin,
rivaroksaban ve fondaparinuksun kırık iyileşmesi üzerine herhangi bir olumsuz
etkisi görülmemiş olup aksine fondaparinuks ve rivaroksabanın bir miktar olumlu
etkilesi olabileceği düşünülmüştür. Rivaroksaban; oral yolla kullanılabilmesi
ve monitörizasyon gerektirmemesi nedeniyle, hastalar tarafından daha kolay
tolere edilebileceği ve diğer antikoagulan ajanlara iyi bir alternatif olacağı
kanaatindeyiz.

Anahtar Kelimeler

Kemik iyileşmesi, Rivaroksaban, Enoksaparin, Fondaparinuks, Rat, Femur Kırığı

Kaynakça

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