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Giving an antithrombotic agent the night after spine surgery appears safe, effective
VIENNA — With few thrombotic events being reported in the literature following spine surgery, Austrian investigators found benefits to postoperatively administering a low-molecular-weight heparin subcutaneously the night after spine surgery and up to 4 weeks afterward in their prospective 150-patient cohort study.
During the 2010 Annual Congress of the Spine Society of Europe (EuroSpine 2010), held here, Michael P. Matzner, MD, of Vienna, presented the results on behalf of investigators, Josef G. Grohs, MD, Andreas Lunzer, MD, and Patrick Vavken, MD, in the orthopedic department at Medical University Vienna.
“Bemiparin postoperative prophylaxis shows no increasing of thromboembolic events. Although the rate of complications is not statistically significant in this sample, it implies a potential of reduction of complication incidence by almost 60%,” he said.
Matzner told Orthopaedics Today Europe that using bemiparin sodium in standard spine surgeries performed at typically-treated levels is now a common practice among members of the department where the study was conducted.
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Image: Rapp SM, Orthopaedics Today Europe |
Audit utilization patterns
The impetus for conducting the study was lack of sufficient data on the comparative effectiveness and safety of preoperatively vs. postoperatively-administered thromboprophylaxis, according to Matzner.
Its goal was to audit the utilization patterns for bemiparin sodium in the two groups.
The study involved 241 patients who underwent surgery that involved opening up the spinal area; 150 patients received their first 3,500 IU/day dose of bemiparin sodium, a low-molecular-weight heparin, on the evening after surgery and 91 patients received the same dose of the drug the day before surgery, serving as the control group.
Fatal thromboembolism as verified by D-dimer and duplex Doppler sonography was the study’s primary endpoint. Secondary endpoints included major bleeding and delayed wound healing.
Endpoints
In the preoperative prophylaxis group, investigators found a 0.11 incidence risk of fatal thromboembolism compared with a 0.01 incidence risk for fatal thromboembolism for the group with postoperative treatment, Matzner said.
Rates of complications were not statistically different in the study, however he noted that during all operations performed in the study group, the operating surgeons noticed a slight decrease in epidural bleeding. – by Susan M. Rapp
Reference:
- Lunzer A, et al. Postoperative antithrombotic therapy after spine operations – negligent or safe and effective? Special Poster Presentation #60. Presented at EuroSpine 2010. Sept. 15-17, 2010. Vienna.
- Michael P. Matzner, MD, can be reached at Vienna Medical Academy, Alser Strasse 4, 1090 Vienna, Austria. +43-1-4051383-20; email: matzner@inca.at.
- Disclosure: Matzner has no relevant financial disclosures.
