Is Blood Loss Greater in Elderly Patients under Antiplatelet or Anticoagulant Medication for Cervical Spine Injury Surgery? A Japanese Multicenter Survey

Abstract

Introduction: In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly. The present multicenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma.Methods: The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well.Results: Of the 776 patients (mean age: 75.1±6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases.Conclusions: This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly.

Safety of Continuing Aspirin Use in Cervical Laminoplasty: A Propensity Score-Matched Analysis

“…In 2022, two studies on aspirin use in cervical spine surgeries were published in Spine Surgery and Related Research 13,14) . In the Japanese multicenter study by Uehara et al 13) , there was no increase in blood loss in elderly patients taking Spine Surgery and Related Research J-STAGE Advance Publication (October 28, 2022) Ⓒ The Japanese Society for Spine Surgery and Related Research. CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/).…”

“…It is a common practice to stop aspirin before spine surgery 3) , but controversy exists concerning whether and when is the optimal time to stop aspirin before spinal surgery 4,5,6) . Several studies and systematic reviews had failed to show an increase in bleeding-related complications with the continual use of aspirin in the perioperative period in spine surgery 7,8,9,10,11,12,13,14) . .…”

“…Nevertheless, most of these studies focused on patients who received thoracolumbar spine surgeries. It was not until 2022 that studies focusing on the use of aspirin in cervical spine surgeries were published 13,14) . In this pilot study, we aim to investigate the safety of the perioperative use of aspirin in patients undergoing cervical laminoplasty.…”

Factores de riesgo y prevalencia de la lesión medular en adultos: una revisión sistemática

“…Por otra parte, los factores de riesgo más frecuentes son los accidentes de tránsito representan el mayor factor de riesgo de llegar a sufrir una lesión medular, presente en 8 de los 15 artículos encontrados (Uehara et al, 2022;Bal et al, 2022;Bellet et al, 2019;Li et al, 2021), esto se debe a que la mayoría de las causas son lesiones de origen traumático, lo cual concuerda con un estudio realizado por James et al (James et al, 2016). Los traumas raquimedulares se presentan mayoritariamente en los grupos de edad menores de los 40 años, siendo los accidentes de tránsito los que ocasionan la muerte o lesiones graves, estos sucesos de dan mayoritariamente en los países en vía de desarrollo a pesar de que la mayor cantidad de automotores están en los países desarrollado (World Health Organization [OMS], 2022).…”

Is Intraoperative Blood Loss Volume in Elderly Cervical Spine Injury Surgery Greater in Patients with Ankylosis? A Multicenter Survey

“…4824) and those of all participating institutions approved the study protocol. The Japan Association of Spine Surgeons with Ambition undertook this examination as part of a multicenter joint study [12][13][14][15][16][17].…”