Does Preoperative DVT Chemoprophylaxis in Spinal Surgery Affect the Incidence of Thromboembolic Complications and Spinal Epidural Hematomas?

Cunningham, John; Swamy, Ganesh; Thomas, Ken

doi:10.1097/bsd.0b013e3181f605ea

Cited by 24 publications

(25 citation statements)

References 15 publications

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“…3 , 12 Low rates of DVT have been demonstrated with chemical VTE prophylaxis after spine surgery, although rates were not signifi cantly different from control groups. 11 Inferior vena cava fi lters represent another effective method for preventing PEs in patients at risk for VTE. 12 When considering surgery on a patient with risk factors identifi ed in our study ( e.g.…”

Section: Resultsmentioning

confidence: 99%

The Incidence and Mortality of Thromboembolic Events in Cervical Spine Surgery

Oglesby

Fineberg

Patel³

et al. 2013

Spine

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Thromboembolic events are potential complications of cervical spine surgery. The highest rates of VTE were identified in those patients undergoing posterior cervical fusion. Regardless of approach, DVT and PEs resulted in increased mortality rates and hospitalization. We recommend a thorough preoperative assessment to identify patients at risk for VTE and treat accordingly to decrease the incidence of these thromboembolic events.

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Section: Resultsmentioning

confidence: 99%

The Incidence and Mortality of Thromboembolic Events in Cervical Spine Surgery

Oglesby

Fineberg

Patel³

et al. 2013

Spine

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“…Some authors have described a significant relation between an increased risk of pSEH and the use of NSAR, 11,28 whereas others have not. 23,[33][34][35] Outcome Our analysis identified some paradigms influencing the level of neurologic outcome after the treatment of pSEH. The prognosis after pSEH strongly depends on the intensity of the symptoms, the interval to revision surgery, the levels of spinal involvement, and the degree of neurologic deficits.…”

Section: Risk Factorsmentioning

confidence: 99%

Symptomatic Postoperative Spinal Epidural Hematoma after Spinal Decompression Surgery: Prevalence, Risk Factors, and Functional Outcome

Hohenberger

Zeman²,

Höhne

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Objective Postoperative spinal epidural hematoma (pSEH) with symptomatic compression of nervous structures after spinal decompression surgery is a rare complication. Delayed evacuation may result in severe neurologic impairment. We present a large single-center analysis of the prevalence, potential risk factors, and functional recovery after pSEH. Methods A retrospective review of our institutional database of spinal decompression surgery over 15 years yielded 6,024 consecutive patients. A total of 42 patients who had undergone surgical revision due to postoperative neurologic deterioration or intractable radiating pain and radiographically confirmed pSEH were allocated to the pSEH group. A matched 3:1 control group was formed (126 patients with the same surgical procedure, same year, same sex, and similar age). Charts, surgical reports, and radiographic data were reviewed for demographics, duration of symptoms, history of medical treatment, medication, comorbidities, radiographic extension, surgical strategy, and pre- and postoperative neurologic performance. Median follow-up was 3 months. Risk factors for pSEH, complete recovery, and recovery of neurologic symptoms were analyzed with univariable and multivariable logistic regression models. Results The prevalence of pSEH in this population was 0.69% (n = 42) with these locations: 7 of 1,284 (0.54%) cervical, 1 of 774 (0.12%) thoracic, and 34 of 3,966 (0.85%) lumbar. Use of anticoagulants (p = 0.003), pathologic coagulation values in the preoperative blood test (p = 0.034), and cigarette smoking (p = 0.003) were identified as independent risk factors of pSEH. Surgery in more than one level showed a trend toward an increased risk of pSEH. Pain as the only symptom (p = 0.0001) was a significant predictor of complete recovery. Patients symptomatic with paraplegia (p = 0.026) had a significantly higher risk of a poor neurologic outcome without full recovery of neurologic symptoms. Conclusion The prevalence of pSEH was lower than previously reported incidences. Use of anticoagulants, pathologic coagulation values, and cigarette smoking were identified as independent risk factors of pSEH. Functional outcome was related to the duration between hematoma evacuation and the clinical presentation of symptomatic pSEH.

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“…To our knowledge, reports of preoperative DVT in patients undergoing spinal surgery are few. [4][5][6] Various prophylactic measures, including mechanical prophylaxis, 4-9 chemical prophylaxis [10][11][12] and the placement of inferior vena cava fi lters 13 , 14 have been reported for prevention of DVT and/or PE after spinal surgery. However, the administration of chemoprophylaxis associated with spinal surgery remains controversial because of the risk of symptomatic postoperative epidural hematoma.…”

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confidence: 99%

Prevalence and Countermeasures for Venous Thromboembolic Diseases Associated With Spinal Surgery

Akeda¹,

Matsunaga²,

Imanishi³

et al. 2014

Spine

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DVT assessment using ultrasonography is important for proper management of VTE during the perioperative period of spinal surgery, especially for high-risk patients, such as those with advanced age or neurological deficit. The institutional protocol for VTE using pneumatic sequential compression device and compression stockings is effective, although the administration of chemoprophylaxis should be considered for high-risk patients, such as those with spinal tumors and spinal trauma.

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Does Preoperative DVT Chemoprophylaxis in Spinal Surgery Affect the Incidence of Thromboembolic Complications and Spinal Epidural Hematomas?

Abstract: Preoperative DVT prophylaxis does not influence the rate of postoperative DVT or PE among elective spinal patients. It probably does not influence SEH rate, and it is noted that SEH may present quite late, in contrast to currently accepted time courses.

Cited by 24 publications

References 15 publications

The Incidence and Mortality of Thromboembolic Events in Cervical Spine Surgery

The Incidence and Mortality of Thromboembolic Events in Cervical Spine Surgery

Symptomatic Postoperative Spinal Epidural Hematoma after Spinal Decompression Surgery: Prevalence, Risk Factors, and Functional Outcome

Prevalence and Countermeasures for Venous Thromboembolic Diseases Associated With Spinal Surgery

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