An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery

Bono, Christopher M.; Watters, William C.; Heggeness, Michael H.; Resnick, Daniel K.; Shaffer, William O.; Baisden, Jamie; Ben‐Galim, Peleg; Easa, John E.; Fernand, Robert; Lamer, Tim J.; Matz, Paul G.; Mendel, Richard C.; Patel, Rajeev K.; Reitman, Charles A.; Toton, John F.

doi:10.1016/j.spinee.2009.09.005

Cited by 117 publications

(115 citation statements)

References 12 publications

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“…A study in which neurosurgery patients underwent weekly venous duplex ultrasonography of the lower extremities reported a high rate (2.8%) of DVTs. 4 It is our institutional practice that patients undergo diagnostic imaging only if they show symptoms or if there is clinical basis to suspect possible DVT or PE. Therefore, it is quite possible that DVT or PE rates may have been actually higher than reported here, although one may argue that "silent" VTEs may not be clinically relevant or not necessitate additional intervention.…”

Section: 2125mentioning

confidence: 99%

“…Anticoagulation therapy is known to reduce thrombotic events; 7,8,21 however, the safety and timing of initiating chemoprophylaxis postoperatively remains controversial. 4,15 The concern with early anticoagulation chemoprophylaxis is the potential risk for bleeding complications, specifically, acute postoperative formation of EDH with significant neurological sequelae.…”

mentioning

confidence: 99%

“…The American College of Chest Physicians 20,21,25 and the North American Spine Society 4 have published guidelines for VTE prevention, but neither provides universal or specific recommendations on which to base treatment decisions. As a result, the Department of Neurosurgery at the University of Florida implemented a standardized VTE-prophylaxis protocol for all patients undergoing spine surgery at this institution.…”

mentioning

confidence: 99%

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Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis

Cox¹,

Weaver²,

Neal³

et al. 2014

SPI

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Object Venous thromboembolism (VTE) represents a significant complication after spine surgery, with reported rates as high as 2%–4%. Published institutional practices for VTE prophylaxis are highly variable. In 2008, the authors implemented a departmental protocol for early VTE prophylaxis consisting of combined compressive devices and subcutaneous heparin initiated either preoperatively or on the same day of surgery. In this study, the authors compared the incidence of VTE in spine surgery patients before and after implementing this protocol. Methods An institutional review board–approved retrospective review of outcomes in patients undergoing spine surgery 2 years before protocol implementation (representing the preprotocol group) and of outcomes in patients treated 2 years thereafter (the postprotocol group) was conducted. Inclusion criteria were that patients were 18 years or older and had been admitted for 1 or more days. Before 2008 (preprotocol), VTE prophylaxis was variable and provider dependent without any uniform protocol. Since 2008 (postprotocol), a new VTE-prophylaxis protocol was administered, starting either preoperatively or on the same day of surgery and continuing throughout hospitalization. The new protocol consisted of 5000 U heparin administered subcutaneously 3 times daily, except in patients older than 75 years or weighing less than 50 kg, who received this dose twice daily. All patients also received sequential compression devices (SCDs). The incidence of VTE in the 2 protocol phases was identified by codes of the International Classification of Diseases, Ninth Revision (ICD-9) codes for deep vein thrombosis (DVT) and pulmonary embolus (PE). Bleeding complications arising from anticoagulation treatments were evaluated by the Current Procedural Terminology (CPT) code for postoperative epidural hematoma (EDH) requiring evacuation. Results In total, 941 patients in the preprotocol group met the inclusion criteria: 25 had DVT (2.7%), 6 had PE (0.6%), and 6 had postoperative EDH (0.6%). In the postprotocol group, 992 patients met the criteria: 10 had DVT (1.0%), 5 had PE (0.5%), and 4 had postoperative EDH (0.4%). This reduction in DVT after the protocol's implementation was statistically significant (p = 0.009). Despite early aggressive prophylaxis, the incidence of postoperative EDH did not increase and compared favorably to the published literature. Conclusions At a high-volume tertiary center, an aggressive protocol for early VTE prophylaxis after spine surgery decreases VTE incidence without increasing morbidity.

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Section: 2125mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis

Cox¹,

Weaver²,

Neal³

et al. 2014

SPI

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“…En cuanto al tiempo estimado de tromboprofilaxis, ambos autores, Ploumis et al 12 y Bono et al 13 establecen el tiempo de terapia antitrombótica por al menos 3 meses después de la lesión, independiente de la clasificación ASIA. (12) Sin embargo, no hay estudios que aclaren las indicaciones de tromboprofilaxis, teniendo en cuenta el nivel y compromiso de la lesión.…”

Section: Discussionunclassified

Análisis retrospectivo descriptivo sobre complicaciones trombóticas y tromboprofilaxis en adultos con trauma raquimedular agudo ASIA E

Herrera

Díaz

Árias

et al. 2016

Rev Col Med Fis Reh

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RESUMENObjetivos: Describir las complicaciones trombóticas y la tromboprofilaxis en pacientes con trauma raquimedular agudo (TRMA) ASIA E, admitidos en la Clínica Universidad de La Sabana. Materiales y métodos:Se realizó un estudio de series de casos retrospectivo observacional descriptivo de pacientes con diagnóstico de TRMA con clasificación ASIA E durante el periodo 2014, 2015 y primeros 5 meses del 2016, con seguimiento a los tres meses.Resultados: Se detectaron 13 pacientes con TRMA clasificación ASIA E. El promedio de edad de los pacientes estaba en 50 años [+/-18,95]. La distribución por género fue de 4 mujeres y 9 hombres (n=13). Con relación al mecanismo de trauma de los pacientes con lesión medular ASIA E, 2/13 (15,38%) fue por aplastamiento y 11/13 (84,62%) por caídas. A los pacientes que recibieron tromboprofilaxis se les formuló enoxaparina, con una dosis de 40 mg SC día. Se realizó tromboprofilaxis farmacológica en 10/13 (76,92%) de los casos de pacientes con TRMA ASIA E. Ninguno presentó complicaciones durante la hospitalización, ni al seguimiento a los 3 meses. Conclusión:En la actualidad existe poca evidencia científica que determine los factores de riesgo trombóticos y la prevención de los mismos en los pacientes con TRMA ASIA E, haciendo que exista una falta de claridad y escasez de guías basadas en la evidencia para este grupo de pacientes. Este artículo es una aproximación para estudios futuros sobre la necesidad y eficacia de la aplicación o no de la tromboprofilaxis farmacológica en ASIA E.

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“…The risk of thromboembolism in elective spine surgery is generally believed to be very low in otherwise healthy patients. Although rarely with complications (such as postoperative bleeding, symptomatic epidural hematoma or potential neurological deficits), considering the potential adverse events associated to anticoagulation, chemical prophylaxis is not routinely recommended in addition to mechanical prophylaxis in elective spinal surgery [47,48] . Evidence-based guidelines for antithrombotic therapies in spine surgery have been established by the North American Spine Society (NASS) [48] and are available via the NASS website [49] .…”

Section: Preventing Pulmonary Embolismmentioning

confidence: 99%

Pulmonary complications after spine surgery

Stundner¹

2012

WJO

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Spine surgery is one of the fastest growing branches of orthopedic surgery. Patients often present with a relatively high acuity and, depending on surgical approach, morbidity and mortality can be comparatively high. Among the most prevalent and most frequently fatalitybound perioperative complications are those affecting the pulmonary system; evidence of clinical or subclinical lung injury triggered by spine surgical procedures is emerging. Increasing burden of comorbidity among the patient population further increases the likelihood of adverse outcome. This review is intended to give an overview over some of the most important causes of pulmonary complications after spine surgery, their pathophysiology and possible ways to reduce harm associated with those conditions. We discuss factors surrounding surgical trauma, timing of surgery, bone marrow and debris embolization, transfusion associated lung injury, and ventilator associated lung injury.

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An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery

Cited by 117 publications

References 12 publications

Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis

Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis

Análisis retrospectivo descriptivo sobre complicaciones trombóticas y tromboprofilaxis en adultos con trauma raquimedular agudo ASIA E

Pulmonary complications after spine surgery

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