Venous Thromboembolism Prophylaxis in Elective Spine Surgery

Abstract

Study Design: Review. Objective: Venothromboembolic (VTE) complications, composed of deep vein thrombosis and pulmonary embolism are commonly observed in the perioperative setting. There are approximately 500 000 postoperative VTE cases annually in the United States and orthopedic procedures contribute significantly to this incidence. Data on the use of VTE prophylaxis in elective spinal surgery is sparse. This review aims to provide an updated consensus within the literature defining the risk factors, diagnosis, and the safety profile of routine use of pharmacological prophylaxis for VTE in elective spine surgery patients. Methods: A comprehensive review of the literature and compilation of findings relating to current identified risk factors for VTE, diagnostic methods, and prophylactic intervention and safety in elective spine surgery. Results: VTE prophylaxis use is still widely contested in elective spine surgery patients. The outlined benefits of mechanical prophylaxis compared with chemical prophylaxis varies among practitioners. Conclusion: The benefits of any form of VTE prophylaxis continues to remain a controversial topic in the elective spine surgery setting. A specific set of guidelines for implementing prophylaxis is yet to be determined. As more risk factors for thromboembolic events are identified, the complexity surrounding intervention selection increases. The benefits of prophylaxis must also continue to be balanced against the increased risk of bleeding events and neurologic injury.

Chemoprophylactic Anticoagulation Following Lumbar Surgery Significantly Reduces Thromboembolic Events After Instrumented Fusions, Not Decompressions

“…vidence-based recommendations are lacking on the safe use of chemoprophylactic anticoagulation to prevent venous thromboembolic event (VTE) after spine surgery, as postoperative bleeding is a concern. [1][2][3] Moreover, some series have even found a paradoxically higher VTE incidence among patients receiving chemoprophylaxis. 2,4,5 A 2020 AO Spine survey found that 70.3% of surgeons base their decision to give chemoprophylaxis on individual patient risk rather than giving it routinely, most commonly based on comorbid disease burden.…”

Safety of Venous Thromboembolism Prophylaxis Protocol Using a Novel Leg Exercise Apparatus in Bedridden Patients due to Spinal Diseases

“…This study protocol was considered feasible and safe. The risk of VTE in elective spinal surgery patients ranges from 0% to 31% [4]. Neither severe adverse events nor symptomatic VTE occurred in this study, and over 90% of the patients completed the protocol.…”

“…Ota et al studied the incidence of VTE and reported its remarkable increase in Japan from 1996 to 2011 [1]. In particular, orthopedic patients are at a higher risk of VTE among all patients, and those who undergo spinal surgery are at risk of VTE [2][3][4][5]. Moreover, patients who underwent spine fracture surgery have a higher VTE rate of 9.2% than that of other spine patients' VTE rate of 2.3%.…”

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

“…The incidence of venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis (DVT) after spinal surgery ranges from 0.3% to 31% (Cheng et al 2010, Fineberg et al 2013, Glotzbecker et al 2009, Kim et al 2011a, Kim et al 2011b, Oda et al 2000; Solaru et al 2020, Takahashi et al 2012). The wide incidence range represents variability in patient population, presentation of symptoms, diagnostic methodology and post-acute care.…”