Effects of thromboprophylaxis on mesenchymal stromal cells during osteogenic differentiation: an in-vitro study comparing enoxaparin with rivaroxaban

• Published in: BMC musculoskeletal disorders 2016-03, Vol.17 (108), p.108, Article 108
• Main Authors: Pilge, Hakan, Fröbel, Julia, Mrotzek, Silvia J, Fischer, Johannes C, Prodinger, Peter M, Zilkens, Christoph, Bittersohl, Bernd, Krauspe, Rüdiger
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Anticoagulants (Medicine); Bone marrow; Bones; Care and treatment; Cell Differentiation - drug effects; Cell Differentiation - physiology; Cells, Cultured; Complications and side effects; Density; Dose-Response Relationship, Drug; Enoxaparin - pharmacology; Female; Fibrinolytic Agents - pharmacology; Fractures; Health aspects; Humans; Joint surgery; Male; Mesenchymal Stromal Cells - drug effects; Mesenchymal Stromal Cells - physiology; Musculoskeletal diseases; Orthopedics; Osteogenesis - drug effects; Osteogenesis - physiology; Phosphatase; Post-Exposure Prophylaxis; Rivaroxaban - pharmacology; Software; Stem cell research; Thromboembolism; Tumor necrosis factor-TNF
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-016-0966-2

Low-molecular-weight heparins (e.g. Enoxaparin) are widely used to prevent venous thromboembolism after orthopaedic surgery, but there are reports about serious side effects including reduction in bone density and strength. In recent years new oral antithrombotic drugs (e.g. direct Factor Xa-inhibitor, Rivaroxaban) have been used to prevent venous thromboembolism. However, there is lack of information on the effects of these new drugs on human mesenchymal stromal cells during osteogenic differentiation and, therefore, effects during postoperative bone healing. We evaluated the effects of Rivaroxaban and Enoxaparin on the proliferation, mRNA and surface receptor expression as well as differentiation capacity of primary human mesenchymal stromal cells during their osteogenic differentiation. Enoxaparin, but not Rivaroxaban treatment significantly increased human mesenchymal stromal cell (hMSC) proliferation during the first week of osteogenic differentiation while suppressing osteogenic marker genes, surface receptor expression and calcification. This is the first paper to demonstrate that Rivaroxaban had no significant influence on hMSC differentiation towards the osteogenic lineage, indicating a less affected bone healing process compared with Enoxaparin in vitro. Based on these findings Rivaroxaban seems to be superior to Enoxaparin in early stages of bone healing in vitro.