Does early multimodal prophylaxis impact VTE post-spine surgery? 5 key notes

Written by Laura Dyrda | October 30, 2014 | Print  |

An article published in the Journal of Neurosurgery: Spine examines whether early multimodal prophylaxis can decrease the incidence of venous thromboemolism after spine surgery.

Researchers conducted a retrospective review of patient outcomes for spine surgery two years before implementing protocol for early VTE prophylaxis and two years after the protocol was implemented.


The new protocol included 5,000 U heparin administered subcutaneously three times daily, except in patients older than 75 or those who weighted more than 50 kg — those patients received a dose twice daily. All the patients also received sequential compression devices.


Here are five findings from the study:


1. Of the 941 patients in the pre-protocol group, the complications included:


•    25 with deep vein thrombosis (2.7 percent)
•    Six with pulmonary embolus (0.6 percent)
•    Six with postoperative epidural hematoma requiring evacuation (0.6 percent)


2. Of the 992 patients in the post-protocol group, complications were:


•    10 had deep vein thrombosis (1 percent)
•    Five had pulmonary embolism (0.5 percent)
•    Four had postoperative epidural hematoma requiring evacuation (0.4 percent)


3. The reduction in DVT after the protocol was statistically significant.


4. Incidence of epidural hematoma requiring evacuation did not increase and compared favorably to the published literature despite early aggressive prophylaxis.


5. The study authors concluded a high-volume tertiary center could benefit from an aggressive protocol for early VTE prophylaxis after spine surgery to decrease VTE without increasing morbidity.


More articles on spine surgery:
The public thinks nurses are more honest than physicians—Can spine surgeons buck this trend?
Spinal fusion economic analysis: Biologic substitutes vs. extenders — Which are cost-effective?
Two-level spine surgery economic analysis: Disc replacement vs. ACDF

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