THE USE OF CHEMOPROPHYLAXIS OR NOT FOR DVT IN SPINE SURGERY: A SYSTEMATIC REVIEW

Cavassin, Bruno Landal; Brandalizze, Carolina Cabral; Rocha, Gabriel Wielisvky; Garbers, Luiz Augusto Fabricio De Melo; Kusma, Solena Ziemer; Teixeira, Fernando Borge; Vialle, Emiliano Neves; Vialle, Luiz Roberto Gomes

doi:10.1590/S1808-185120222102258863

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Review Article, Deformities • Coluna/Columna 21 (2) • 2022 • https://doi.org/10.1590/S1808-185120222102258863 copy

THE USE OF CHEMOPROPHYLAXIS OR NOT FOR DVT IN SPINE SURGERY: A SYSTEMATIC REVIEW

O USO DA QUIMIOPROFILAXIA OU NÃO PARA TVP EM CIRURGIA DE COLUNA: REVISÃO SISTEMÁTICA

EL USO DE QUIMIOPROFILAXIS O NO PARA LA TVP EN LA CIRUGÍA DE COLUMNA VERTEBRAL: REVISIÓN SISTEMÁTICA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To compare pharmacological and non-pharmacological prophylaxis in elective spine surgery to determine the risks of DVT, PTE, and epidural hematoma (EH) in both groups, as well as their respective treatment effectiveness.

Methods:

Systematic review and meta-analysis based on systematically searched articles, using combinations of MeSH terms related to chemoprophylaxis and non-chemoprophylaxis for prevention of deep vein thrombosis and pulmonary embolism in elective spine surgery. Adult patients were eligible for inclusion in the study, except for those with trauma, spinal cord injury, neoplasms, or those using vena cava filters.

Results:

Five studies were selected for this systematic review and meta-analysis: 3 retrospective studies, 1 prospective study, and 1 case series. Data analysis showed that 4.64% of patients treated with chemoprophylaxis had an unfavorable outcome regarding DVT, while this outcome occurred in 1.14% of patients not treated with chemoprophylaxis (p=0.001). Among patients using chemoprophylaxis, only 0.1% developed epidural hematoma and 0.38% developed PTE. Among those on non-pharmaceutical prophylaxis, 0.04% had EH (p=0.11) and 0.42% had PTE (p=0.45).

Conclusions:

No benefits were found for chemoprophylaxis as compared to non-chemoprophylaxis in preventing DVT in elective spine surgery, nor was there an increased risk of epidural hematoma or fatal thromboembolic events. Level of evidence III; Therapeutic studies; Investigation of treatment results.

Keywords:
Chemoprevention; Venous Thrombosis; Pulmonary Embolism; Spinal Epidural Hematoma; Spine; Systematic Review

Study (Author)	Design	Sample size	Chemoprophylaxis	n	DVT	PE	EH	Non-chemoprophylaxis	n	DVT	PE	EH
Rokito et al.¹⁵15 Rokito SE, Schwartz MC, Neuwirth MG. Deep vein thrombosis after major reconstructive spinal surgery. Spine (Phila Pa 1976). 1996;21(7):853-8. doi:10.1097/00007632-199604010-00016 https://doi.org/10.1097/00007632-1996040...	Prospective study	77	Coumadin 10 mg + CS	35	0	0	0	CS	42	0	0	0
Nicol et al.¹⁶16 Nicol M, Sun Y, Craig N, Wardlaw D. Incidence of thromboembolic complications in lumbar spinal surgery in 1,111 patients. Eur Spine J. 2009;18(10):1548-52. doi:10.1007/s00586-009-1035-4 https://doi.org/10.1007/s00586-009-1035-...	Retrospective study	1111	Aspirin 150mg/day or LMWH (if aspirin is contraindicated) + CS + SCD	414	1	0	NR	SCD and/or CS or Nothing	697	2	0	NR
Weber et al.¹⁷17 Weber B, Seal A, McGirr J, Fielding K. Case series of elective instrumented posterior lumbar spinal fusions demonstrating a low incidence of venous thromboembolism. ANZ J Surg. 2016;86(10):796-800. doi:10.1111/ans.12702 https://doi.org/10.1111/ans.12702...	Single-center case series study	107	LMWH + CS + SCD	40	0	0	0	SCD and CS	67	2	2	0
Yang et al.⁸8 Yang SD, Liu H, Sun YP, Yang DL, Shen Y, Feng SQ, et al. Prevalence and risk factors of deep vein thrombosis in patients after spine surgery: A retrospective case-cohort study. Sci Rep. 2015;5(June):11834. doi:10.1038/srep11834 https://doi.org/10.1038/srep11834...	Retrospective case cohort study	807	LMWH (4100UI/day)	721	97	0	NR	"Mechanical"	86	7	0	NR
Dhillon et al.¹¹11 Dhillon ES, Khanna R, Cloney M, Roberts H, Cybulski GR, Koski TR, et al. Timing and risks of chemoprophylaxis after spinal surgery: a single-center experience with 6869 consecutive patients. J Neurosurg Spine. 2017;27(6):681-93. doi:10.3171/2017.3.SPINE161076. https://doi.org/10.3171/2017.3.SPINE1610...	Retrospective study	6506	5000 U of Heparin or 40 mg of Enoxaparin or 2500 - 5000 U of Dalteparin, or 2.5 mg of Fondaparinux	1697	37	11	3	"Non-chemoprophylaxis"	4809	54	22	2

Study (Author)	Year	Country	Mean Age (Years)	Male	Female	DVT exam	PE exam	Type of surgery
Rokito et al.¹⁵15 Rokito SE, Schwartz MC, Neuwirth MG. Deep vein thrombosis after major reconstructive spinal surgery. Spine (Phila Pa 1976). 1996;21(7):853-8. doi:10.1097/00007632-199604010-00016 https://doi.org/10.1097/00007632-1996040...	1996	USA	45	≈40%	≈60%	US	NR	Cervical, thoracic, or lumbar - Anterior and/or posterior spinal fusions and/or decompressions
Nicol et al.¹⁶16 Nicol M, Sun Y, Craig N, Wardlaw D. Incidence of thromboembolic complications in lumbar spinal surgery in 1,111 patients. Eur Spine J. 2009;18(10):1548-52. doi:10.1007/s00586-009-1035-4 https://doi.org/10.1007/s00586-009-1035-...	2009	Scotland	NR	NR	NR	US	NR	Laminotomy, decompression and disc enucleation + posterolateral spinal fusion, with or without decompression or pedicular fixation
Weber et al.¹⁷17 Weber B, Seal A, McGirr J, Fielding K. Case series of elective instrumented posterior lumbar spinal fusions demonstrating a low incidence of venous thromboembolism. ANZ J Surg. 2016;86(10):796-800. doi:10.1111/ans.12702 https://doi.org/10.1111/ans.12702...	2014	Australia	≈58	≈42%	≈58%	US	CTPA	Laminectomy and insertion of pedicle screws
Yang et al.⁸8 Yang SD, Liu H, Sun YP, Yang DL, Shen Y, Feng SQ, et al. Prevalence and risk factors of deep vein thrombosis in patients after spine surgery: A retrospective case-cohort study. Sci Rep. 2015;5(June):11834. doi:10.1038/srep11834 https://doi.org/10.1038/srep11834...	2015	China	≈55.25	NR	NR	US	NR	Interbody fusion and fixation, single level, double level, ≥3 levels
Dhillon et al.¹¹11 Dhillon ES, Khanna R, Cloney M, Roberts H, Cybulski GR, Koski TR, et al. Timing and risks of chemoprophylaxis after spinal surgery: a single-center experience with 6869 consecutive patients. J Neurosurg Spine. 2017;27(6):681-93. doi:10.3171/2017.3.SPINE161076. https://doi.org/10.3171/2017.3.SPINE1610...	2017	USA	≈55.78	≈53%	≈47%	NR	NR	Cervical, thoracic, lumbar, or other; whether a fusion and/or decompression (laminectomy or laminotomy) was part of the procedure

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[1] Correspondence: Fernando Borge Teixeira. Alameda Princesa Izabel, 605, Centro, Curitiba, Paraná, Brasil. 80430-120. nandoborget@gmail.com