Fewer VTEs seen in elective spine surgeries with use of chemical prophylaxis

Although venous thromboembolism events are recognized as potential complications following spine surgery, results of a retrospective study showed the occurrence rate can be decreased through combined mechanical and pharmacological prophylaxis used at 6 hours postoperatively.

Compared with individuals who were treated with mechanical prophylaxis alone following spinal surgery, patients who received the combined treatment had lower rates of venous thromboembolism (VTE) events, according to Hassan M.T. Fawi, MBBS, MRCS, Eng.

“None of those who developed VTE were from the combined prophylaxis group. We report an overall low incidence of VTE from our large cohort of elective spinal surgery, excluding cervical surgery. Our protocol of preoperative anti-embolism stocking usage, early mobilization and optimum hydration may have contributed to this,” he told Spine Surgery Today.

Andrew Cunningham, MBBcH, MRCS, a colleague of Fawi’s, presented the findings at the 16th EFORT Congress.

Generally low VTE rates

The study included 2,472 spinal operations performed from 2007 to 2012 at the University Hospital of Wales, in Cardiff, United Kingdom.

All patients received mechanical prophylaxis in the form of lower-limb compression stockings postoperatively. However, 515 patients also received pharmacological prophylaxis that consisted of low molecular-weight heparin (LMWH) that was started at 6 hours postoperatively.

The investigators followed up patients at 3 months postoperatively and recorded their incidence of VTE.

VTE was diagnosed with spiral chest CT scans, venous duplex scans or ventilation-perfusion scans.

In the cohort, 38% underwent decompression surgery; 20% underwent posterior thoracic/lumbar fusion for adult degenerative spine; 19% underwent transforaminal lumbar interbody fusion; 13% underwent decompression and placement of interspinous spacers; 7% underwent anterior lumbar interbody fusion; 1% underwent extreme lateral interbody fusion and 2% underwent miscellaneous procedures, Fawi said.

No serious VTEs

All the patients were mobilized on the first postoperative day under adequate analgesia and with optimum hydration.

“The prevalence of symptomatic VTE was 0.4%, symptomatic pulmonary embolism (PE) was 0.36%, and symptomatic deep vein thrombosis (DVT) was 0.04%,” Fawi said.

In the mechanical prophylaxis alone cohort, nine patients had confirmed PE and one had a confirmed DVT.

Seven patients in the chemical prophylaxis combination group were investigated for a DVT event, but none of those were confirmed. Eight patients were investigated for a PE and none were identified.

“Combining the aforementioned protocol with pharmacological prophylaxis with LMWH at 6 hours postoperatively until discharge has yielded a 0% VTE incidence, albeit its effect was statistically insignificant but its use in the study group was uneventful,” Fawi said.

In addition, the results showed no return to surgery or serious complications related to the use of chemical prophylaxis – by Robert Linnehan

Reference:
Fawi H, et al. Paper #2560. Presented at: 16th EFORT Congress; May 27-29, 2015; Prague.

For more information:
Hassan M.T. Fawi, MBBS, MRCS, Eng, can be reached at University Hospital of Wales in Heath Park, Cardiff CF14 4XW, United Kingdom; email: hassanfawi@doctors.org.uk.

Disclosure: Fawi reports no relevant financial disclosures.