Saturday, April 6, 2013

Effect of asprin on healing

Effect of Aspirin on Bone Healing in a Rabbit Ulnar Osteotomy Model

What does this have to do with rotator cuff repair? 
Well, we think that in cuff repair surgery, the bone heals to the tendon, so it seems that drugs that impair bone healing may interfere with the healing of cuff repairs. 

It is recognized that nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with delayed bone healing. These authors study effects of aspirin on bone healing.

Following ulnar osteotomy, fifty-six rabbits were administered a placebo (nine rabbits), indomethacin (nine rabbits given 12.5 mg/kg daily), or aspirin at various doses and schedules (2.7 mg/kg daily for ten rabbits, 10 mg/kg daily for nine rabbits, 50 mg/kg twice daily for ten rabbits, and 100 mg/kg three times daily for nine rabbits). The aspirin doses were chosen to span the clinical dosing range. The indomethacin group served as a positive control and as a relative comparison with the effect of aspirin. Radiographs were obtained every two weeks and the animals were killed at eight weeks. Mechanical testing was performed on all rabbits except for six selected for histological evaluation.

The authors found that aspirin delayed bone healing in a dose-dependent fashion at salicylate levels equivalent to those resulting from typical human dosing (low-dose aspirin 325 mg). Receiver operating characteristic analysis demonstrated a plasma salicylate threshold above 20.7 μg/mL predicting delayed bone healing. This approximates a single human dose of 325 mg. Salicylate levels above this threshold were associated with delayed bone healing similar to that caused by indomethacin. 

This study should cause us to consider the possibility that asprin and non-steroidal anti-inflammatory medications may impair healing after surgery.

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