Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Incidence of Venous Thromboembolic Complications in Instrumental Spinal Surgeries with Preoperative Chemoprophylaxis

  • Hamidi, Saeed (Division of Neurosurgery, Department of Surgery, Bou-Ali Medical-Educational & Clinical Center, Tehran Medical Science Branch, Islamic Azad University) ;
  • Riazi, Mahdieh (Medical Science Research Center, Tehran Medical Science Branch, Islamic Azad University)
  • Received : 2014.03.15
  • Accepted : 2014.10.17
  • Published : 2015.02.28
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Abstract

Objective : Venous thromboembolism (VTE) after spinal surgery affects a patients' postoperative recovery and also carries a mortality risk. Some studies recommended chemical prophylaxis for high-risk patients and for those after complex spinal surgeries. However, chemoprophylaxis for VTE in spinal surgery is underemployed and there is no agreement on the use of VTE prophylaxis in spinal surgery. The aim of this study was to document the incidence of VTE after an elective instrumental spinal surgery, among those receiving preoperative chemoprophylaxis as compared with patients who did not receive it. Methods : This study was carried out on eighty-nine patients allocated randomly to receive either low molecular weight heparin (LMWH) or no prophylaxis before elective instrumental spinal surgery. All patients received postoperative compression stockings. A compression Doppler ultrasonography was performed for all patients to detect postoperative deep vein thrombosis. In addition, further imaging studies were performed for patients suspected of VTE. Results : Three (3.3%) patients were diagnosed with VTE. One of them had received preoperative chemoprophylaxis. There were no significant difference in incidence of VTE between the two groups (p>0.95; 95% confidence interval, 0.06-8.7). Laterality of gender and postsurgical recumbence duration were all independent predictors of VTE (p=0.01 and p<0.001, respectively). Conclusion : The difference in the incidence of thromboembolic complications between the two groups was not significant. Moreover, we found that preoperative prophylactic LMWH injection has no major bleeding complications altering postoperative course; still, the issue concerning the initiation time of chemoprophylaxis in spinal surgery remains unclear.

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References

  1. Agnelli G, Piovella F, Buoncristiani P, Severi P, Pini M, D'Angelo A, et al. : Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elec-tive neurosurgery. N Engl J Med 339 : 80-85, 1998 https://doi.org/10.1056/NEJM199807093390204
  2. Anderson FA Jr, Spencer FA : Risk factors for venous thromboembolism. Circulation 107 (23 Suppl 1) : I9-I16, 2003 https://doi.org/10.1161/01.CIR.0000046771.12875.6C
  3. Bono CM, Watters WC 3rd, Heggeness MH, Resnick DK, Shaffer WO, Baisden J, et al. : An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery. Spine J 9 : 1046-1051, 2009 https://doi.org/10.1016/j.spinee.2009.09.005
  4. Cabana F, Pointillart V, Vital J, Senegas J : [Postoperative compressive spinal epidural hematomas. 15 cases and a review of the literature]. Rev Chir Orthop Reparatrice Appar Mot 86 : 335-345, 2000
  5. Cunningham JE, Swamy G, Thomas KC : Does preoperative DVT chemoprophylaxis in spinal surgery affect the incidence of thromboembolic complications and spinal epidural hematomas? J Spinal Disord Tech 24 : E31-E34, 2011 https://doi.org/10.1097/BSD.0b013e3181f605ea
  6. Davidson HC, Mazzu D, Gage BF, Jeffrey RB : Screening for deep venous thrombosis in asymptomatic postoperative orthopedic patients using color Doppler sonography : analysis of prevalence and risk factors. AJR Am J Roentgenol 166 : 659-662, 1996 https://doi.org/10.2214/ajr.166.3.8623645
  7. Epstein NE : A review of the risks and benefits of differing prophylaxis regimens for the treatment of deep venous thrombosis and pulmonary embolism in neurosurgery. Surg Neurol 64 : 295-301; discussion 302, 2005 https://doi.org/10.1016/j.surneu.2005.04.039
  8. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. : Prevention of venous thromboembolism : American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133 (6 Suppl) : 381S-453S, 2008 https://doi.org/10.1378/chest.08-0656
  9. Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA Jr, et al. : Prevention of venous thromboembolism. Chest 119 (1 Suppl) : 132S-175S, 2001 https://doi.org/10.1378/chest.119.1_suppl.132S
  10. Gerlach R, Raabe A, Beck J, Woszczyk A, Seifert V : Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery. Eur Spine J 13 : 9-13, 2004 https://doi.org/10.1007/s00586-003-0642-8
  11. Glotzbecker MP, Bono CM, Harris MB, Brick G, Heary RF, Wood KB : Surgeon practices regarding postoperative thromboembolic prophylaxis after high-risk spinal surgery. Spine (Phila Pa 1976) 33 : 2915-2921, 2008 https://doi.org/10.1097/BRS.0b013e318190702a
  12. Glotzbecker MP, Bono CM, Wood KB, Harris MB : Postoperative spinal epidural hematoma : a systematic review. Spine (Phila Pa 1976) 35 : E413-E420, 2010 https://doi.org/10.1097/BRS.0b013e3181d9bb77
  13. Glotzbecker MP, Bono CM, Wood KB, Harris MB : Thromboembolic disease in spinal surgery : a systematic review. Spine (Phila Pa 1976) 34 : 291-303, 2009 https://doi.org/10.1097/BRS.0b013e318195601d
  14. Jaffer AK : An overview of venous thromboembolism : impact, risks, and issues in prophylaxis. Cleve Clin J Med 75 Suppl 3 : S3-S36, 2008
  15. Johns JS, Nguyen C, Sing RF : Vena cava filters in spinal cord injuries : evolving technology. J Spinal Cord Med 29 : 183-190, 2006 https://doi.org/10.1080/10790268.2006.11753873
  16. Khan I, Nadeem M, Rabbani ZH : Thoracolumbar junction injuries and their management with pedicle screws. J Ayub Med Coll Abbottabad 19 : 7-10, 2007
  17. Leon L, Rodriguez H, Tawk RG, Ondra SL, Labropoulos N, Morasch MD : The prophylactic use of inferior vena cava filters in patients undergoing high-risk spinal surgery. Ann Vasc Surg 19 : 442-447, 2005 https://doi.org/10.1007/s10016-005-0025-1
  18. Oda T, Fuji T, Kato Y, Fujita S, Kanemitsu N : Deep venous thrombosis after posterior spinal surgery. Spine (Phila Pa 1976) 25 : 2962-2967, 2000 https://doi.org/10.1097/00007632-200011150-00019
  19. Piasecki DP, Poynton AR, Mintz DN, Roh JS, Peterson MG, Rawlins BA, et al. : Thromboembolic disease after combined anterior/posterior reconstruction for adult spinal deformity : a prospective cohort study using magnetic resonance venography. Spine (Phila Pa 1976) 33 : 668-672, 2008 https://doi.org/10.1097/BRS.0b013e318166dfa3
  20. Platzer P, Thalhammer G, Jaindl M, Obradovic A, Benesch T, Vecsei V, et al. : Thromboembolic complications after spinal surgery in trauma patients. Acta Orthop 77 : 755-760, 2006 https://doi.org/10.1080/17453670610012944
  21. Schizas C, Neumayer F, Kosmopoulos V : Incidence and management of pulmonary embolism following spinal surgery occurring while under chemical thromboprophylaxis. Eur Spine J 17 : 970-974, 2008 https://doi.org/10.1007/s00586-008-0668-z
  22. Smith JS, Fu KM, Polly DW Jr, Sansur CA, Berven SH, Broadstone PA, et al. : Complication rates of three common spine procedures and rates of thromboembolism following spine surgery based on 108,419 procedures : a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 35 : 2140-2149, 2010 https://doi.org/10.1097/BRS.0b013e3181cbc8e7
  23. Strom RG, Frempong-Boadu AK : Low-molecular-weight heparin prophylaxis 24 to 36 hours after degenerative spine surgery : risk of hemorrhage and venous thromboembolism. Spine (Phila Pa 1976) 38 : E1498-E1502, 2013 https://doi.org/10.1097/BRS.0b013e3182a4408d
  24. Takahashi H, Yokoyama Y, Iida Y, Terashima F, Hasegawa K, Saito T, et al. : Incidence of venous thromboembolism after spine surgery. J Orthop Sci 17 : 114-117, 2012 https://doi.org/10.1007/s00776-011-0188-2

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