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Venous thromboembolism and prophylaxis therapy after elective spine surgery: a population-based study
Megan Fiasconaro1, Jashvant Poeran2,3, Jiabin Liu1,4
1Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|November 19, 2020
Summary
This study found no difference in venous thromboembolism (VTE) or hematoma rates among spine surgery patients using aspirin, regular heparin, or low molecular weight heparin for prophylaxis. However, aspirin and regular heparin were linked to higher blood transfusion rates.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Pharmacology
Background:
- Consensus on perioperative venous thromboembolism (VTE) prophylaxis in spine surgery patients is lacking.
- Large-scale studies are absent, necessitating analysis of national data.
Purpose of the Study:
- To investigate the association between anticoagulant prophylaxis and VTE in spine surgery.
- To evaluate the impact of prophylaxis on hematoma and blood transfusion rates as secondary outcomes.
Main Methods:
- Analysis of anterior cervical discectomy and fusion (ACDF) and posterior lumbar fusion (PLF) cases (2006-2016) from the Premier Healthcare database.
- Categorization of anticoagulant prophylaxis into aspirin, regular heparin, and low molecular weight heparin administered on the day of surgery.
- Utilized mixed-effects models with adjustments for confounding factors to assess outcomes.
Main Results:
- Among 83,839 patients, VTE occurred in 0.13%, hematoma in 0.45%, and blood transfusion in 8.1%.
- Prophylactic aspirin and regular heparin were associated with increased odds of blood transfusion (OR 1.48 and 2.01, respectively).
- No significant differences in hematoma or VTE odds were observed across anticoagulant groups.
Conclusions:
- Low molecular weight heparin showed a trend towards lower transfusion incidence compared to aspirin and regular heparin.
- All evaluated anticoagulants demonstrated similar rates of VTE and hematoma.
- Further research into subgroup-specific VTE risks is recommended to optimize chemical thromboprophylaxis strategies.
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