Use of Fondaparinux Following Elective Lumbar Spine Surgery Is Associated With a Reduction in Symptomatic Venous Thromboembolism

Abstract

Study Design: Retrospective cohort study. Objective: To assess the impact of fondaparinux on venous thromboembolism (VTE) following elective lumbar spine surgery in high-risk patients. Methods: Matched patient cohorts who did or did not receive inpatient fondaparinux starting postoperative day 2 following elective lumbar spine surgery were compared. All patients received 1 month of acetyl salicylic acid 325 mg following discharge. The primary outcome was a symptomatic DVT (deep vein thrombosis) or PE (pulmonary embolus) within 30 days of surgery. Secondary outcomes included prolonged wound drainage, epidural hematoma, and transfusion. Results: A significantly higher number of DVTs were diagnosed in the group that did not receive inpatient VTE prophylaxis (3/102, 2.9%) compared with the fondaparinux group (0/275, 0%, P = .02). Increased wound drainage was seen in 18.5% of patients administered fondaparinux, compared with 25.5% of untreated patients ( P = .15). Deep infections were equivalent (2.2% with fondaparinux vs 4.9% control, P = .18). No epidural hematomas were noted, and the number of transfusions after postoperative day 2 and 90-day return to operating room rates were equivalent. Conclusions: Patients receiving fondaparinux had lower rates of symptomatic DVT and PE and a favorable complication profile when compared with matched controls. The retrospective nature of this work limits the safety and efficacy claims that can be made about the use of fondaparinux to prevent VTE in elective lumbar spine surgery patients. Importantly, this work highlights the potential safety of this regimen, permitting future high-quality trials.

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

“…None - - - Fourman et al. [39] 1. Aspirin 59.0±14.5 - 30.8±7.7 Thoracolumbar, lumbar, lumbosacral 2.Aspirin+Fondaparinux 61.7±13.0 - 31.3±6.7 Zervos et al.…”

“…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 1 (0.5) 1 (0.5) 0 (0) 2 (0.9) Fourman et al. [39] 1. Aspirin 5 (4.9) 3 (2.9) 2 (2.0) 0 (0) 2.Aspirin+Fondaparinux 1 (0.4) 0 (0) 1 (0.4) 0 (0) Zervos et al.…”

Efficacy and Safety Study of Low-Molecular-Weight Heparin and Fondaparinux Sodium After Hip Arthroplasty: A Retrospective Cohort Study

“…Its pentose structure significantly increases the affinity of antithrombin (AT), which specifically binds to the activation site of antithrombin through its non-covalent bond, resulting in the rapid inhibition of activated coagulation factor X, which in turn reduces the production of prothrombin and fibrin formation. 15 , 16 This results in rapid inhibition of activated factor X, thereby reducing thrombin production and fibrin formation. Unlike UFH and LMWH, sodium sulfadiazepoxide is not expected to bind to platelet factor IV and does not cross-react with plasma from patients with heparin-induced thrombocytopenia.…”