Antithrombotic Therapy in Spinal Surgery Does Not Impact Patient Safety-A Single Center Cohort Study

Area of Science:

• Neurosurgery
• Cardiology
• Pharmacology

Background:

• Antithrombotic therapy is crucial for preventing thromboembolic events in older adults.
• Perioperative management of antithrombotic agents requires careful consideration, especially before spinal surgery.
• Current guidelines lack specific recommendations for the timing of anticoagulation interruption for spinal procedures.

Purpose of the Study:

• To evaluate the clinical outcomes of patients undergoing spinal surgery after interrupting antithrombotic therapy.
• To assess the safety and efficacy of perioperative antithrombotic drug management in spinal surgery patients.

Main Methods:

• Retrospective cohort study of 217 patients undergoing dorsal instrumentation (January 2019 - December 2020).
• Group A: Vitamin K antagonists (VKA) suspended for 5 days, direct oral anticoagulants (DOAC) for 3 days.
• Group B: Antiplatelet agents (APA) paused for at least 7 days. Group C: Control (no anticoagulation).
• Analysis included demographic data, comorbidities, surgical details, blood loss, complications, thromboembolism, and mortality.

Main Results:

• Patients on anticoagulation (VKA/DOAC/APA) were older and had more comorbidities than the control group.
• No significant differences were observed in procedural bleeding, surgery duration, hospital stay, complication rates, thromboembolism, or 30-day mortality between groups.
• p > 0.05 for all comparative analyses.

Conclusions:

• Dorsal instrumentation can be safely performed in patients whose antithrombotic therapy is temporarily interrupted.
• Perioperative interruption of VKA, DOAC, and APA appears safe for spinal surgery, with outcomes comparable to non-anticoagulated patients.