Anticoagulation and Spine Surgery

Porto, Guilherme; Wessell, DO Jeffrey; Alvarado, Anthony M.; Arnold, Paul M.; Buchholz, Avery L.

doi:10.1177/2192568219852051

Cited by 15 publications

(14 citation statements)

References 35 publications

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“…Current guidelines also recommended Plavix be discontinued for 5 to 7 days to prevent complications. Nonetheless, randomized control trials are needed in order to provide definitive guidance [31].…”

Section: Implications and Relevancementioning

confidence: 99%

The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study

Arena

Sabharwal

et al. 2020

BMC Musculoskelet Disord

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Background Although stroke is a rare complication among spinal surgery patients, the recognition of this adverse event is critical given the aging population undergoing surgical procedures. The objective of this study was to estimate the incidence of stroke among selected adults undergoing elective posterior lumbar fusion (PLF) during various post-operative risk windows and among different subgroups. Methods A retrospective cohort study using a longitudinal electronic healthcare record (EHR) database was conducted from January 1, 2007 to June 30, 2018. Elective PLF, stroke, and select clinical characteristics were defined based on International Classification of Disease codes. Patients aged 18 to 85 years with ≥183 days of enrollment in the database prior to undergoing elective PLF were followed from the index date until the occurrence of stroke, death, loss to follow-up, or end of study period, whichever occurred first. The incidence of stroke was estimated in the following risk windows: index hospitalization, ≤ 30 days, ≤ 90 days, ≤ 180 days, and ≤ 365 days post-operation. Results A total of 43,063 patients were eligible for the study. The incidence of stroke following elective PLF was 0.29% (95% confidence interval [CI]: 0.25, 0.35%) during index hospitalization, 0.44% (95% CI: 0.38, 0.50%) ≤ 30 days, 0.59% (95% CI: 0.52, 0.67%) ≤ 90 days, 0.76% (95% CI: 0.68, 0.85%) ≤ 180 days, and 1.12% (95% CI: 1.03, 1.23%) ≤ 365 days post-operation. Stratified analyses revealed that older patients had a higher incidence of stroke. Additionally, black patients had higher stroke incidences. Post-operative stroke incidence was higher among patients with a history of type 2 diabetes than among patients without such history; similarly, stroke incidence was higher among patients with a history of stroke compared to patients without such history. Conclusions The incidence of stroke following elective PLF using an EHR database in this study is slightly higher than that reported in the literature. Our results suggest that stroke risk modification prior to PLF may be important for patients who are older, black, type 2 diabetic, and/or have a history of stroke.

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Section: Implications and Relevancementioning

confidence: 99%

The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study

Arena

Sabharwal

et al. 2020

BMC Musculoskelet Disord

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“…Therefore, etiology of SSEH in our case may be anticoagulant therapy due to mitral valve replacement. There are few guidelines available when to restart anticoagulation therapy after the spine surgery to reduce the risk of thromboembolism related complications [10,15,16]. However, no literature suggests how to manage perioperatively w h e n a p a t i e n t w i t h a h i g h -r i s k o f d e v e l o p i n g thromboembolism needs to undergo spine surgery.…”

Section: Discussionmentioning

confidence: 99%

“…There are a few reports available suggesting when to stop anticoagulation therapy if a patient is on anticoagulation therapy requiring spine surgery [8,9]. There is also a report suggesting when to restart anticoagulation therapy once spine surgery is over depending on type of anticoagulation agent [10]. However, there is no report available regarding perioperative management of anticoagulation treatment for such high-risk patient suggesting when develop SSEH.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Spinal Epidural Hematoma Causing Paraparesis in a Patient of Mitral Valve Replacement with Anticoagulant Treatment – A Decision Dilemma

Modi¹,

Patel²

2022

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Summary and Background: Spontaneous spinal epidural hematoma (SSEH) is a known occurrence in patients on anticoagulant therapy. There is an increased risk of developing hematoma after the spine surgery if anticoagulation therapy is reinstated. Purpose of Study: The purpose of the study was to find out solution related with perioperative anticoagulant therapy in high-risk cases if patient redevelops hematoma and paraplegia due to continuation of anticoagulant therapy. Case Report: A 30-year-old male presented to us with history of progressive paraparesis. He had history of mitral valve replacement twice followed by cerebrovascular stroke and on regular oral anticoagulant therapy. Magnetic resonance imaging revealed SSEH from C6-T1 level with cord compression. Initial decision was taken to conservatively treat as his coagulation parameters were altered and he was on high-risk for developing thromboembolism related complications if anticoagulant medicines were stopped. However, urgent laminectomy and evacuation of SSEH had to be performed due to rapid worsening of neurology. Postoperatively, patient had significant neurological recovery and anticoagulant therapy reinstated after 12 h of surgery. Patient developed acute paraplegia within 2 hours of anticoagulant therapy due to post-operative hematoma, which was drained out by opening the wound bedside. He regained neurological recovery within 5 min. Anticoagulation therapy was withheld for next 36 hours and reinstated with low-dose intravenous heparin followed by low-molecular weight heparin without any complications. His coagulation parameters and 2-D echo were followed up daily to check cardiac conditions. Patient improved clinically and became self-ambulatory. Conclusion: Post-operative hematoma after spine surgery should be kept in mind in patients who are on anticoagulant treatment. Reinstating anticoagulation treatment in such high-risk patients should be done with lot of caution and initially with low-dose heparin followed by regular anticoagulation therapy. Close observation on neurological status is must to avoid permanent neurological injury. Keywords: Spontaneous spinal epidural hematoma, Anticoagulat treatment, Decision dilemma

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Section: Implications and Relevancementioning

confidence: 99%

The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study

Arena

Sabharwal

et al. 2020

Preprint

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Background: Although stroke is a rare complication among spinal surgery patients, the recognition of this adverse event is critical given the aging population undergoing surgical procedures. The objective of this study was to estimate the incidence of stroke among selected adults undergoing elective posterior lumbar fusion (PLF) during various post-operative risk windows and among different subgroups.Methods: A retrospective cohort study using a longitudinal electronic healthcare record (EHR) database was conducted from January 1, 2007 to June 30, 2018. Elective PLF, stroke, and select clinical characteristics were defined based on International Classification of Disease codes. Patients aged 18 to 85 years with ≥ 183 days of enrollment in the database prior to undergoing elective PLF were followed from the index date until the occurrence of stroke, death, loss to follow-up, or end of study period, whichever occurred first. The incidence of stroke was estimated in the following risk windows: index hospitalization, ≤ 30 days, ≤ 90 days, ≤ 180 days, and ≤ 365 days post-operationResults: A total of 43,063 patients were eligible for the study. The incidence of stroke following elective PLF was 0.29% (95% confidence interval [CI]: 0.25%, 0.35%) during index hospitalization, 0.44% (95% CI: 0.38%, 0.50%) ≤ 30 days, 0.59% (95% CI: 0.52%, 0.67%) ≤ 90 days, 0.76% (95% CI: 0.68%, 0.85%) ≤ 180 days, and 1.12% (95% CI: 1.03%, 1.23%) ≤ 365 days post-operation. Stratified analyses revealed that older patients had a higher incidence of stroke. Additionally, black patients had higher stroke incidences. Post-operative stroke incidence was higher among patients with a history of type 2 diabetes than among patients without such history; similarly, stroke incidence was higher among patients with a history of stroke compared to patients without such history.Conclusions: The incidence of stroke following elective PLF using an EHR database in this study is slightly higher than that reported in the literature. Our results suggest that stroke risk modification prior to PLF may be important for patients who are older, black, type 2 diabetic, and/or have a history of stroke.

show abstract

Anticoagulation and Spine Surgery

Cited by 15 publications

References 35 publications

The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study

The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study

Spontaneous Spinal Epidural Hematoma Causing Paraparesis in a Patient of Mitral Valve Replacement with Anticoagulant Treatment – A Decision Dilemma

The incidence of stroke among selected patients undergoing elective posterior lumbar fusion: a retrospective cohort study

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