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

被引:1
作者
Rahmani, Roman [1 ]
Eaddy, Samuel [1 ]
Stegelmann, Samuel D. [2 ]
Skrobot, Gabriel [1 ]
Andreshak, Thomas [1 ]
机构
[1] Mercy Hlth St Vincent Med Ctr, Dept Orthoped, 2409 Cherry St,Suite 10, Toledo, OH 43608 USA
[2] HCA Med City Healthcare UNT TCU GME Denton, 3535 S Interstate 35, Denton, TX 76210 USA
来源
NORTH AMERICAN SPINE SOCIETY JOURNAL | 2024年 / 17卷
关键词
Thrombosis; Chemoprophylaxis; Anticoagulation; Elective; Spine surgery; Venous thromboembolism; Deep vein thrombosis; Pulmonary embolism; Spinal epidural hematoma; Thromboprophylaxis; DEEP-VEIN THROMBOSIS; PULMONARY-EMBOLISM; RISK-FACTORS; EPIDURAL HEMATOMA; DISEASE;
D O I
10.1016/j.xnsj.2023.100295
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially devastating complication after surgery. Spine surgery is associated with an increased risk of postoperative bleeding, such as spinal epidural hematomas (SEH), which complicates the use of anticoagulation. Despite this dilemma, there is a lack of consensus around perioperative VTE prophylaxis. This systematic review investigates the relationship between chemoprophylaxis and the incidence rates of VTE and SEH in the elective spine surgical population. Methods: A comprehensive literature search was performed using PubMed, Embase, and Cochrane databases to identify studies published after 2,000 that compared VTE chemoprophylaxis use in elective spine surgery. Studies involving patients aged < 18 years or with known trauma, cancer, or spinal cord injuries were excluded. Pooled incidence rates of VTE and SEH were calculated for all eligible studies, and meta-analyses were performed to assess the relationship between chemoprophylaxis and the incidences of VTE and SEH. Results: Nineteen studies met our eligibility criteria, comprising a total of 220,932 patients. The overall pooled incidence of VTE was 3.2%, including 3.3% for DVT and 0.4% for PE. A comparison of VTE incidence between patients that did and did not receive chemoprophylaxis was not statistically significant (OR 0.97, p = .95, 95% CI 0.43-2.19). The overall pooled incidence of SEH was 0.4%, and there was also no significant difference between patients that did and did not receive chemoprophylaxis (OR 1.57, p = .06, 95% CI 0.99-2.50). Conclusions: The use of perioperative chemoprophylaxis may not significantly alter rates of VTE or SEH in the elective spine surgery population. This review highlights the need for additional randomized controlled trials to better define the risks and benefits of specific chemoprophylactic protocols in various subpopulations of elective spine surgery.
引用
收藏
页数:9
相关论文
共 44 条
[1]   Venous Thromboembolism Prophylaxis in Elective Neurosurgery: A Survey of Board-Certified Neurosurgeons in the United States and Updated Literature Review [J].
Adeeb, Nimer ;
Hattab, Tariq ;
Savardekar, Amey ;
Jumah, Fareed ;
Griessenauer, Christoph J. ;
Musmar, Basel ;
Adeeb, Abdallah ;
Trosclair, Krystle ;
Guthikonda, Bharat .
WORLD NEUROSURGERY, 2021, 150 :E631-E638
[2]   An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery [J].
Bono, Christopher M. ;
Watters, William C., III ;
Heggeness, Michael H. ;
Resnick, Daniel K. ;
Shaffer, William O. ;
Baisden, Jamie ;
Ben-Galim, Peleg ;
Easa, John E. ;
Fernand, Robert ;
Lamer, Tim ;
Matz, Paul G. ;
Mendel, Richard C. ;
Patel, Rajeev K. ;
Reitman, Charles A. ;
Toton, John F. .
SPINE JOURNAL, 2009, 9 (12) :1046-1051
[3]   Post-operative spinal epidural hematoma causing American Spinal Injury Association B spinal cord injury in patients with suction wound drains [J].
Chimenti, Peter ;
Molinari, Robert .
JOURNAL OF SPINAL CORD MEDICINE, 2013, 36 (03) :213-219
[4]   Chemoprophylactic Anticoagulation Following Lumbar Surgery Significantly Reduces Thromboembolic Events After Instrumented Fusions, Not Decompressions [J].
Cloney, Michael B. ;
Hopkins, Benjamin ;
Dhillon, Ekamjeet ;
El Tecle, Najib ;
Koski, Tyler R. ;
Dahdaleh, Nader S. .
SPINE, 2023, 48 (03) :172-179
[5]   Thromboprophylaxis in elective spinal surgery A protocol for systematic review [J].
Colomina, Maria J. ;
Bago, Joan ;
Perez-Bracchiglione, Javier ;
Nishishinya Aquino, Maria Betina ;
Salas, Karla R. ;
Requeijo, Carolina ;
Urrutia, Gerard .
MEDICINE, 2020, 99 (21)
[6]   Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis [J].
Cox, J. Bridger ;
Weaver, Kristin J. ;
Neal, Daniel W. ;
Jacob, R. Patrick ;
Hoh, Daniel J. .
JOURNAL OF NEUROSURGERY-SPINE, 2014, 21 (04) :677-684
[7]   Does Preoperative DVT Chemoprophylaxis in Spinal Surgery Affect the Incidence of Thromboembolic Complications and Spinal Epidural Hematomas? [J].
Cunningham, John Edward ;
Swamy, Ganesh ;
Thomas, Ken C. .
JOURNAL OF SPINAL DISORDERS & TECHNIQUES, 2011, 24 (04) :E31-E34
[8]   Deep vein thrombosis and pulmonary embolism in two cohorts: The longitudinal investigation of thromboembolism etiology [J].
Cushman, M ;
Tsai, AW ;
White, RH ;
Heckbert, SR ;
Rosamond, WD ;
Enright, P ;
Folsom, AR .
AMERICAN JOURNAL OF MEDICINE, 2004, 117 (01) :19-25
[9]   Comparison of rivaroxaban and parnaparin for preventing venous thromboembolism after lumbar spine surgery [J].
Du, Wei ;
Zhao, Chunhong ;
Wang, Jingjie ;
Liu, Jianqing ;
Shen, Binghua ;
Zheng, Yanping .
JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH, 2015, 10
[10]   Pharmacoprophylaxis for Venous Thromboembolism in Spinal Surgery: A Systematic Review and Meta-analysis [J].
Ellenbogen, Yosef ;
Power, Robert G. ;
Martyniuk, Amanda ;
Engels, Paul T. ;
Sharma, Sunjay, V ;
Kasper, Ekkehard M. .
WORLD NEUROSURGERY, 2021, 150 :E144-E154