The risks and benefits of early venous thromboembolism prophylaxis after elective spinal surgery: A single-centre experience

Abstract

Background There is a wide ranging incidence of venous thromboembolism after surgery and it continues to be a major cause of morbidity after spinal procedures.This study’s aim was to investigate the relationship between timing and administration of venous thromboembolism (VTE) pharmacologic chemoprophylaxis after spinal surgery and the resulting VTE and bleeding complications by reviewing current practices and outcomes at a high-volume single institution to better define opportunities for perioperative intervention to prevent VTE without increasing bleeding complications. Methods All patients who underwent elective one or two-stage lumbar spinal fusion procedures were identified. A logistic regression was used to evaluate (1) risk of symptomatic VTE within 30 days of surgery and (2) bleeding-related complications. The odds of developing a VTE as well as bleeding-related complications were compared among the three treatment groups: no chemoprophylaxis, chemoprophylaxis < 24h of surgery and chemoprophylaxis given > 24h post-surgery. Results When adjusted for doses administered, the odds of developing a postoperative VTE within 30 days were 0.189 (95% confidence interval (0.044, 0.808)) in patients who received anticoagulation < 24h postoperatively, compared to those who received no anticoagulation (p = 0.025). There was no difference in bleeding rates. Conclusion Patients undergoing elective spinal surgery who received anticoagulation within 24h of the conclusion of their procedure had an 81% reduction in the odds of developing a deep vein thrombosis within 30 days with no significant difference in bleeding complications.

Chemical prophylaxis and venous thromboembolism following elective spinal surgery: A systematic review and meta-analysis

“…Countries of origin included the United States (52.6%), China (15.8%), United Kingdom (10.5%), Iran (10.5%), Canada (5.3%), and Australia (5.3%). Fourteen studies used patient data from single-center institutional populations, with an average sample size of 1,145 [14 , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , 35] . Two studies used data from national databases, comprising an average sample size of 101,864 [36 , 37] .…”

“…None 35 - - - Kiguchi et al. [30] R 1. Heparin ≤24 h 105 5,000 U ≤24 h postoperatively SCD (88.6%) 2.…”

“…Mean patient age ranged from 47 to 66 years [28 , 31] among the 7 studies that reported average age for the entire sample [14 , 25 , [27] , [28] , [29] , [30] , [31] . Most patients were women in 8 of the 13 studies that reported sex [25 , 27 , 28 , 30 , 33 , 34 , 38 , 39] . The average BMI was 29.3, although sample-wide BMI averages were only reported in 5 (26.3%) studies [14 , 27 , 29 , 31 , 34] .…”

“…None 65.5±12.1 - 31.6±7.1 Cervical (48), lumbar (87) Kiguchi et al. [30] 1. Heparin ≤24 h 57.8±12.5 69 (65.7) - All lumbar 2.…”

Recommendations from the ICM-VTE: Spine

“…In terms of retrospective reviews, one group evaluated patients who underwent elective one- or two-stage lumbar spinal fusions at a high-volume single institution 106 . This group found the odds of developing a VTE within 30 day was reduced in those who received chemoprophylaxis withing 24 hours of surgery (odds ratio = 0.189, p = 0.025) with no difference in bleeding rates.…”