Chemical prophylaxis and venous thromboembolism following elective spinal surgery: A systematic review and meta-analysis
ABSTRACT: Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially devastating complication after surgery. Spine surgery is associated with an increased risk of postoperative bleeding, such as spinal epidural hematomas (SEH), which...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | North American Spine Society Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548423000975 |
| _version_ | 1797253913894715392 |
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| author | Roman Rahmani, DO Samuel Eaddy, MS Samuel D. Stegelmann, MD Gabriel Skrobot, BS Thomas Andreshak, MD |
| author_facet | Roman Rahmani, DO Samuel Eaddy, MS Samuel D. Stegelmann, MD Gabriel Skrobot, BS Thomas Andreshak, MD |
| author_sort | Roman Rahmani, DO |
| collection | DOAJ |
| description | ABSTRACT: Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially devastating complication after surgery. Spine surgery is associated with an increased risk of postoperative bleeding, such as spinal epidural hematomas (SEH), which complicates the use of anticoagulation. Despite this dilemma, there is a lack of consensus around perioperative VTE prophylaxis. This systematic review investigates the relationship between chemoprophylaxis and the incidence rates of VTE and SEH in the elective spine surgical population. Methods: A comprehensive literature search was performed using PubMed, Embase, and Cochrane databases to identify studies published after 2,000 that compared VTE chemoprophylaxis use in elective spine surgery. Studies involving patients aged < 18 years or with known trauma, cancer, or spinal cord injuries were excluded. Pooled incidence rates of VTE and SEH were calculated for all eligible studies, and meta-analyses were performed to assess the relationship between chemoprophylaxis and the incidences of VTE and SEH. Results: Nineteen studies met our eligibility criteria, comprising a total of 220,932 patients. The overall pooled incidence of VTE was 3.2%, including 3.3% for DVT and 0.4% for PE. A comparison of VTE incidence between patients that did and did not receive chemoprophylaxis was not statistically significant (OR 0.97, p=.95, 95% CI 0.43–2.19). The overall pooled incidence of SEH was 0.4%, and there was also no significant difference between patients that did and did not receive chemoprophylaxis (OR 1.57, p=.06, 95% CI 0.99–2.50). Conclusions: The use of perioperative chemoprophylaxis may not significantly alter rates of VTE or SEH in the elective spine surgery population. This review highlights the need for additional randomized controlled trials to better define the risks and benefits of specific chemoprophylactic protocols in various subpopulations of elective spine surgery. |
| first_indexed | 2024-03-08T20:10:10Z |
| format | Article |
| id | doaj.art-7bebb40670434d8c8e1c6ab5cb3ea939 |
| institution | Directory Open Access Journal |
| issn | 2666-5484 |
| language | English |
| last_indexed | 2024-04-24T21:41:37Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | North American Spine Society Journal |
| spelling | doaj.art-7bebb40670434d8c8e1c6ab5cb3ea9392024-03-21T05:37:47ZengElsevierNorth American Spine Society Journal2666-54842024-03-0117100295Chemical prophylaxis and venous thromboembolism following elective spinal surgery: A systematic review and meta-analysisRoman Rahmani, DO0Samuel Eaddy, MS1Samuel D. Stegelmann, MD2Gabriel Skrobot, BS3Thomas Andreshak, MD4Mercy Health St. Vincent Medical Center, Department of Orthopedics, 2409 Cherry St, Suite #10, Toledo, OH 43608, United StatesMercy Health St. Vincent Medical Center, Department of Orthopedics, 2409 Cherry St, Suite #10, Toledo, OH 43608, United States; Corresponding author. Mercy Health St. Vincent Medical Center, Department of Orthopedics, 2409 Cherry St, Suite #10, Toledo, OH 43608, USA. Tel.: (419) 251-6553, fax: (419) 251-9672.HCA Medical City Healthcare UNT-TCU GME (Denton), 3535 S Interstate 35, Denton, TX 76210, United StatesMercy Health St. Vincent Medical Center, Department of Orthopedics, 2409 Cherry St, Suite #10, Toledo, OH 43608, United StatesMercy Health St. Vincent Medical Center, Department of Orthopedics, 2409 Cherry St, Suite #10, Toledo, OH 43608, United StatesABSTRACT: Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially devastating complication after surgery. Spine surgery is associated with an increased risk of postoperative bleeding, such as spinal epidural hematomas (SEH), which complicates the use of anticoagulation. Despite this dilemma, there is a lack of consensus around perioperative VTE prophylaxis. This systematic review investigates the relationship between chemoprophylaxis and the incidence rates of VTE and SEH in the elective spine surgical population. Methods: A comprehensive literature search was performed using PubMed, Embase, and Cochrane databases to identify studies published after 2,000 that compared VTE chemoprophylaxis use in elective spine surgery. Studies involving patients aged < 18 years or with known trauma, cancer, or spinal cord injuries were excluded. Pooled incidence rates of VTE and SEH were calculated for all eligible studies, and meta-analyses were performed to assess the relationship between chemoprophylaxis and the incidences of VTE and SEH. Results: Nineteen studies met our eligibility criteria, comprising a total of 220,932 patients. The overall pooled incidence of VTE was 3.2%, including 3.3% for DVT and 0.4% for PE. A comparison of VTE incidence between patients that did and did not receive chemoprophylaxis was not statistically significant (OR 0.97, p=.95, 95% CI 0.43–2.19). The overall pooled incidence of SEH was 0.4%, and there was also no significant difference between patients that did and did not receive chemoprophylaxis (OR 1.57, p=.06, 95% CI 0.99–2.50). Conclusions: The use of perioperative chemoprophylaxis may not significantly alter rates of VTE or SEH in the elective spine surgery population. This review highlights the need for additional randomized controlled trials to better define the risks and benefits of specific chemoprophylactic protocols in various subpopulations of elective spine surgery.http://www.sciencedirect.com/science/article/pii/S2666548423000975ThrombosisChemoprophylaxisAnticoagulationElectiveSpine surgeryVenous thromboembolism |
| spellingShingle | Roman Rahmani, DO Samuel Eaddy, MS Samuel D. Stegelmann, MD Gabriel Skrobot, BS Thomas Andreshak, MD Chemical prophylaxis and venous thromboembolism following elective spinal surgery: A systematic review and meta-analysis North American Spine Society Journal Thrombosis Chemoprophylaxis Anticoagulation Elective Spine surgery Venous thromboembolism |
| title | Chemical prophylaxis and venous thromboembolism following elective spinal surgery: A systematic review and meta-analysis |
| title_full | Chemical prophylaxis and venous thromboembolism following elective spinal surgery: A systematic review and meta-analysis |
| title_fullStr | Chemical prophylaxis and venous thromboembolism following elective spinal surgery: A systematic review and meta-analysis |
| title_full_unstemmed | Chemical prophylaxis and venous thromboembolism following elective spinal surgery: A systematic review and meta-analysis |
| title_short | Chemical prophylaxis and venous thromboembolism following elective spinal surgery: A systematic review and meta-analysis |
| title_sort | chemical prophylaxis and venous thromboembolism following elective spinal surgery a systematic review and meta analysis |
| topic | Thrombosis Chemoprophylaxis Anticoagulation Elective Spine surgery Venous thromboembolism |
| url | http://www.sciencedirect.com/science/article/pii/S2666548423000975 |
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