A decade of experience in over 300 surgically treated spine patients with long-term oral anticoagulation: a propensity score matched cohort study

被引:0
作者
Sweda, Romy [1 ,2 ]
Mannion, Anne F. [1 ]
O'Riordan, Dave [1 ]
Haschtmann, Daniel [1 ]
Loibl, Markus [1 ]
Kleinstueck, Frank [1 ]
Jeszenszky, Dezso [1 ]
Galbusera, Fabio [1 ]
Fekete, Tamas F. [1 ]
机构
[1] Schulthess Klin, Spine Ctr, Lengghalde 2, CH-8008 Zurich, Switzerland
[2] Univ Bern, Bern Univ Hosp, Inselspital, Dept Cardiol, Bern, Switzerland
关键词
Spine surgery; Oral anticoagulation; Vitamin K antagonist; Mechanical heart valve; Bleeding; Epidural haematoma; MOLECULAR-WEIGHT HEPARIN; UNFRACTIONATED HEPARIN; BRIDGING THERAPY; RISK-FACTORS; SEPARATION; INFECTION; OUTCOMES;
D O I
10.1007/s00586-024-08134-8
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Purpose The aim of this study was to investigate the risks and outcomes of patients with long-term oral anticoagulation (OAC) undergoing spine surgery. Methods All patients on long-term OAC who underwent spine surgery between 01/2005 and 06/2015 were included. Data were prospectively collected within our in-house Spine Surgery registry and retrospectively supplemented with patient chart and administrative database information. A 1:1 propensity score-matched group of patients without OAC from the same time interval served as control. Primary outcomes were post-operative bleeding, wound complications and thromboembolic events up to 90 days post-surgery. Secondary outcomes included intraoperative blood loss, length of hospital stay, death and 3-month post-operative patient-rated outcomes. Results In comparison with the control group, patients with OAC (n = 332) had a 3.4-fold (95%CI 1.3-9.0) higher risk for post-operative bleeding, whereas the risks for wound complications and thromboembolic events were comparable between groups. The higher bleeding risk was driven by a higher rate of extraspinal haematomas (3.3% vs. 0.6%; p = 0.001), while there was no difference in epidural haematomas and haematoma evacuations. Risk factors for adverse events among patients with OAC were mechanical heart valves, posterior neck surgery, blood loss > 1000 mL, age, female sex, BMI > 30 kg/m(2) and post-operative PTT levels. At 3-month follow-up, most patients reported favourable outcomes with no difference between groups. Conclusion Although OAC patients have a higher risk for complications after spine surgery, the risk for major events is low and patients benefit similarly from surgery.
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收藏
页码:1360 / 1368
页数:9
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