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Anticoagulation and Spine Surgery.

Guilherme B F Porto1, D O Jeffrey Wessell1, Anthony Alvarado2

  • 1Medical University of South Carolina, Charleston, SC, USA.

Global Spine Journal
|January 15, 2020
PubMed
Summary
This summary is machine-generated.

Managing anticoagulation before spine surgery is key to prevent clots and bleeding. This review clarifies guidelines for warfarin, heparin, and antiplatelet agents to ensure patient safety during surgery.

Keywords:
antiplatelet agentsblood loss surgicalmanagement guidelinespostoperative hematomaspine surgery and perioperative anticoagulation

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Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Pharmacology

Background:

  • Preoperative management of therapeutic anticoagulation in spine surgery is critical.
  • Balancing the risk of thromboembolic events with postsurgical complications is essential.
  • Existing guidelines often rely on drug half-lives, necessitating evidence-based clarification.

Purpose of the Study:

  • To clarify current guidelines for preoperative anticoagulation management in spine surgery.
  • To review available evidence for the safe practice of spine surgery in patients on anticoagulation.
  • To optimize anticoagulation strategies for spine surgery patients.

Main Methods:

  • A comprehensive literature search was conducted in PubMed.
  • Inclusion and exclusion criteria were predefined for study selection.
  • Data extraction was performed on 17 selected articles (12 retrospective chart reviews, 3 prospective observational studies, 2 systematic reviews).

Main Results:

  • Warfarin should be held until international normalized ratio (INR) <1.4.
  • Direct Factor Xa inhibitors require 48–72 hours discontinuation.
  • Low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) require 12–24 hours and 4–24 hours discontinuation, respectively.
  • Antiplatelet agents like aspirin (81–500 mg) require 1–3 days, higher doses (>1 g/d) 1 week, and clopidogrel (Plavix) 5–7 days discontinuation.

Conclusions:

  • The review outlines preoperative anticoagulation guidelines for spine surgery patients.
  • Evidence supports the need for specific guidelines despite mixed data and lack of randomized controlled trials.
  • Further research is needed to assess complication risks with therapeutic anticoagulation levels in various comorbid conditions.