Up-to-date thromboprophylaxis in elective spinal surgery. A
               systematic review

Oliveira, Leonardo; Marchi, Luis; Pimenta, Luiz

doi:10.1590/S1808-18512014130200413

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Sumário

Systematic Review • Coluna/Columna 13 (02) • 2014 • https://doi.org/10.1590/S1808-18512014130200413 copy

Up-to-date thromboprophylaxis in elective spinal surgery. A systematic review

Atualização em tromboprofilaxia em cirurgias eletivas da coluna vertebral. Revisão sistemática

Actualización sobre la tromboprofilaxis en cirugía electiva de columna. Una revisión sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Deep vein thrombosis (DVT) and pulmonary embolism (PE) present a high incidence after surgery, posing a high risk in surgical practice. Although a consensus does exist on thromboprophylaxis in orthopedic surgery, this topic remains controversial in regard to spinal surgery. In this current paper, we review and discuss the different forms of prophyilaxis presented in literature, in order to develop guidelines on prophylactic measures in spinal surgery, improving patient´s outcomes and reducing any medical/legal problems that could arise from a thrombotic complication.

Venous thromboembolism; Pulmonary embolism; Spine/surgery; Postoperative complications

		Study design	Type of surgical procedure	Number of patients	Prophylaxis	Incidence of VTE	Incidence of symptomatic PTE	Diagnostic method
1	Yoshioka et al¹⁰	Comparativeprospective	Lumbar or lower thoracic decompression with or without instrumentation Cervical decompression with or without instrumentation Spinal tumors	340	Mechanical (compression stockings and intermittent pneumatic compression devices)	13.5%	2.9%	Duplex US
2	Oglesby et al¹¹	Retrospectivedatabase analysis	Posterior and anterior cervical fusion Posterior cervicaldecompression	273,396	Not available	0.38%	0.15%	Not available
3	Fineberg et al¹²	Retrospectivedatabase analysis	Lumbar fusion or decompression	578,457	Not available	0.34%	0.18%	Not available
4	Al-Dujaili et al¹³	Single centerprospective	Spinal sugery (excluding facetary inflitration, vertebroplasty, epidural injection, and thermocoagulation of the medial branch)	158	Mechanical(compression stockings) Chemical (low molecular weight heparin)	0.63%	Zero	Clinical and Doppler US
5	Gephart et al¹⁴	Retrospective database analysis	Spinal fusion	430,081	Not available	0.4%	not available	Not available
6	Kim et al¹⁵	Retrospective database analysis	Spinal fusion	3331	Not available	0.24%	1%	Spiral CT
7	Takahashi et al¹⁶	Retrospective database analysis	Lumbar fusion ordecompression	1975	Without prophylaxis Intermittent pneumatic compression devices and compression stockings	19%	0.56%	D-Dimer
8	Cunninghamet al¹⁷	Retrospective database analysis	Spinal surgery	3870	Without prophylaxisChemoprophylaxis	0.28%	0.31%	Not available
9	Yoshiiwa et al¹⁸	Retrospective database analysis	Spinal surgery	88	Mechanical (compression stockings and intermittent pneumatic compression devices)	5.68%	2.27%	D-DImer
10	Smith et al¹⁹	Retrospective analysis of prospectively collected data	Lumbar microdiscectomy Anterior cervical fusion Lumbar decompression	108,419	Not available	0.12%	0.14%	Not available
11	Schizas et al²⁰	Single centerprospective	Lumbar fusion ordecompression	270	Compression stockings and low molecular weight heparin	not available	2.22%	Spiral CT
12	Piasecki et al²¹	Single center prospective	Anterior posterior reconstruction of spinal deformity	66	Mechanical (compression stockings and intermittent pneumatic compression devices)	9.1%	7.6%	Magnetic resonance venography, Doppler US, and Spiral CT
13	Epstein²²	Single center prospective	Posterior fusion with instrumentation and laminectomy	139	Compression stockings	2.8%	0.7%	Doppler US
14	Oskouian and Johnson²³	Retrospective database analysis	Anterior thoracic and lumbar spinal reconstruction	207	Not available	2.42%	0.48%	Not available
15	Oda et al²⁴	Single center prospective	Posterior spinal surgery	110	Without prophylaxis	15.5%	0%	Bilateral ascending venography
16	Lee et al²⁵	Single center prospective	Major spinal surgery	313	Without prophylaxis	1.3%	0%	Duplex US
17	Dearborn et al²⁶	Retrospective database analysis	Major spinal surgery	116	Mechanical (compression stockings and intermittent pneumatic compression devices)	0.86%	2.2%	Duplex US
18	Rajaramanet al²⁷	Single center prospective	Anterior spinal surgery	50	Not available	1.67%	0%	Doppler US
19	Wood et al²⁸	Prospective, comparative, and randomized	Major spinal surgery	136	Pneumatic compression stockings or pneumatic thigh compression bandages	1.47%	0.74%	Duplex US
20	Rokito et al²⁹	Single center prospective	Major spinal surgery	329	Compression stockings of the thigh, calf, or a low dose of coumadin	0.3%	0%	Doppler US
21	Nelson et al³⁰	Single center prospective	Posterior spinal fusion	117	Compression stockings and intermittent pneumatic compression pumps	0%	0%	Duplex US
22	Smith et al³¹	Single center prospective	Spinal reconstruction	317	Compression stockings and intermittent pneumatic compression devices	0.95%	0.32%	Duplex US
23	Ferree³²	Single center prospective	Lumbar laminectomy	60	Compression stockings	5%	0%	Not available
24	Ferree andWright³³	Single center prospective	Posterior spinal surgery	185	Elastic compression stockings or intermittent pneumatic compression devices	2.16%	not available	Duplex US
25	Ferree et al³⁴	Single center prospective	Spinal surgery	86	Not available	6%	not available	Not available
26	West andAnderson³⁵	Single center prospective	Posterior spinal surgery	41	Not available	14%	not available	Duplex Doppler US

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[1] Correspondence: Rua Vergueiro, 1421, Sala 305 - 04101-000 São Paulo, SP, Brazil. Leonardo@patologiadacoluna.com.br