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Thromboprophylaxis in Spinal Surgery

Mosenthal, William P. MD; Landy, David C. MD; Boyajian, Haroutioun H. MD; Idowu, Olumuyiwa A. BA; Shi, Lewis L. MD; Ramos, Edwin MD; Lee, Michael J. MD

doi: 10.1097/BRS.0000000000002379

Study Design. Systematic review and meta-analysis.

Objective. Determine the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in spinal surgery patients receiving no thromboprophylaxis, mechanoprophylaxis, and chemoprophylaxis.

Summary of Background Data. The incidence of thromboembolic complications after spinal surgery is not well established. Although a variety of effective mechanical and chemical thromboprophylaxis interventions exist, their role in spinal surgery remains unclear. Spine surgeons are faced with the difficult decision of balancing the risk of death from a thromboembolic complication against the risk of permanent neurological damage from an epidural hematoma (EDH).

Methods. The Medline database was queried using combinations of the terms related to the aforementioned subject matter. Articles meeting our predetermined inclusion criteria were reviewed and relevant data extracted. Meta-analyses were created using a random-effects model for incidence of DVT and PE by type of thromboprophylaxis, method of screening, and study type.

Results. Twenty-eight articles were included in the final analyses. The higher mean incidence of DVT and PE in the mechanoprophylaxis group (DVT: 1%, PE: 0.81%) compared to the chemoprophylaxis group (DVT: 0.85%, PE: 0.58%) was not observed to be statistically significant. Six percent of PEs was fatal; the rate of EDHs was 0.3%. The incidence of DVT was higher in prospective studies (1.4%) compared to retrospective studies (0.61%); the incidence of DVT was not affected by whether the study screened only symptomatic patients.

Conclusion. Although the incidence of DVT and PE was relatively low regardless of prophylaxis type, the true incidence is difficult to determine given the heterogeneous nature of the small number of studies available in the literature. Our findings suggest there may be a role for chemoprophylaxis given the relatively high rate of fatal PE. Future studies are needed to determine which patient population would benefit most from chemoprophylaxis.

Level of Evidence: 2

Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine Division of Biological Sciences, Chicago, IL

Department of Surgery, Section of Neurosurgery, University of Chicago Medicine Division of Biological Sciences, Chicago, IL.

Address correspondence and reprint requests to William P. Mosenthal, MD, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine, 5841 S. Maryland Ave, MC3079, Chicago, IL 60637; E-mail:

Received 25 April, 2017

Revised 29 June, 2017

Accepted 2 August, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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