Thromboprophylaxis in elective spinal surgery
Colomina Soler, M. J. (María José) (Hospital Universitari de Bellvitge)
Bago, Joan (Hospital Universitari Vall d'Hebron)
Pérez-Bracchiglione, Javier (Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Chile)
Nishishinya Aquino, Maria Betina (Institut d'Investigació Biomèdica Sant Pau)
Salas-Gama, Karla (Institut d'Investigació Biomèdica Sant Pau)
Requeijo, Carolina (Institut d'Investigació Biomèdica Sant Pau)
Urrútia, Gerard (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Date:	2020
Abstract:	Supplemental Digital Content is available in the text Venous thromboembolism (VTE) is a serious, sometimes life-threatening complication that can occur following spine surgery. The incidence of VTE, and the optimal type and timing of thromboprophylaxis for this complication in elective spine surgery is a matter of debate. To perform a systematic review with the aim of clarifying the efficacy and adverse effects of mechanical and chemical prophylaxis for preventing thromboembolic complications in elective spine surgery for conditions other than trauma and malignant disease. A search strategy of related articles up to March 2018 was designed and executed in Medline and Embase. Patients: adolescents (>10 years) and adults undergoing elective surgery for spinal deformity or degenerative disease (from C1 to S1). Intervention: Perioperative mechanical and chemical thromboprophylaxis. Studies could be randomized controlled trials or observational studies that reported data on any relevant clinical outcomes. In total, 2451 uniquecitations were identified and 35 studies were ultimately included in the systematic review. The overall mean incidence of complications was 3. 7% for deep venous thrombosis, 0. 0% for pulmonary embolism, and 3. 7% for bleeding in chemoprophylaxis group; 2. 9% for deep venous thrombosis, 0. 4% for pulmonary embolism and 0. 0% for bleeding in mechanoprophylaxis; and 0. 7% for deep venous thrombosis, 0. 1% for pulmonary embolism and 0. 2% for bleeding in mixed prophylaxis group with no specific data on these rates for the type of patient and type and location of surgery. None of the articles retrieved provided information on the adolescent population. The poor design and high variability among the studies regarding characteristics of study population, details of interventions, and definitions of outcomes, determines a low quality of the available evidence and limits the interpretation of the results. We were unable to identify a clear advantage of one type of thromboprophylaxis over the other, although there was an increased risk of bleeding with chemoprophylaxis, which could favor the use of mechanoprophylaxis in this scenario.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Chemoprophylaxis ; Deep vein thrombosis ; Epidural hematoma ; Mechanoprophylaxis ; Pulmonary embolism ; Spine surgery ; Thromboprophylaxis
Published in:	Medicine, Vol. 99 (may 2020) , ISSN 1536-5964

DOI: 10.1097/MD.0000000000020127
PMID: 32481281

14 p, 562.9 KB

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