Venous Thromboembolic Events in Spine Surgery Patients: Which Patients Are High Risk?

SummaryAcute medical patients have a high risk of venous thromboembolic events (VTE). Unfortunately, the fear of bleeding complications limits the use of antithrombotic prophylaxis in this setting. To stratify the VTE and haemorrhagic risk, two clinical scores (PADUA, IMPROVE) have recently been developed. However, it is not clear how many patients have a concomitant high VTE and haemorrhagic risk and what is the use of prophylaxis in this situation. To clarify these issues we performed a prospective cohort study enrolling consecutive patients admitted to internal medicine. Patients admitted to internal medicine (January to December 2013) were included. VTE and haemorrhagic risk were evaluated in all the included patients. Use and type of anti-thrombotic prophylaxis was recorded. A total of 1761 patients (mean age 77.6 years) were enrolled; 76.8 % (95 % CI 74.7–78.7) were at high VTE risk and 11.9 % (95 % CI 10.4–13.5) were at high haemorrhagic risk. Anti-thrombotic prophylaxis was used in 80.5 % of patients at high VTE risk and in 6.5 % at low VTE risk (p< 0.001), and in 16.6 % at high haemorrhagic risk and in 72.5 % at low haemorrhagic risk (p< 0.001). Prophylaxis was used in 20.4 % at both high VTE and haemorrhagic risk and in 88.9 % at high VTE risk but low haemor-rhagic risk. At multivariate-analysis, use of prophylaxis appeared highly influenced by the VTE risk (OR 68.2, 95 % CI 43.1 - 108.0). In conclusion, many patients admitted to internal medicine were at high risk of VTE. Since almost 90 % of them were at low haemorrhagic risk, pharmacological prophylaxis may be safely prescribed in most of these patients.Supplementary Material to this article is available online at www.thrombosis-online.com.

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The timing of venous thromboembolic events after spine surgery: a single-center experience with 6869 consecutive patients

Journal of Neurosurgery Spine ◽

10.3171/2017.5.spine161399 ◽

2018 ◽

Vol 28 (1) ◽

pp. 88-95 ◽

Cited By ~ 8

Author(s):

Michael B. Cloney ◽

Benjamin Hopkins ◽

Ekamjeet S. Dhillon ◽

Nader S. Dahdaleh

Keyword(s):

Spine Surgery ◽

Postoperative Period ◽

Cumulative Incidence ◽

Thromboembolic Events ◽

Single Center Experience ◽

Linear Relationships ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Hospital Stays ◽

Selection For

OBJECTIVEVenous thromboembolic events (VTEs), including both deep venous thrombosis (DVT) and pulmonary embolism, are a major cause of morbidity and mortality after spine surgery. Prophylactic anticoagulation, or chemoprophylaxis, can prevent VTE. However, the timing of VTEs after spine surgery and the effect of chemoprophylaxis on VTE timing remain underinvestigated.METHODSThe records of 6869 consecutive spine surgeries were retrospectively examined. Data on patient demographics, surgical variables, hospital course, and timing of VTEs were collected. Patients who received chemoprophylaxis were compared with those who did not. Appropriate regression models were used to examine selection for chemoprophylaxis and the timing of VTEs.RESULTSAge (OR 1.037, 95% CI 1.023–1.051; p < 0.001), longer surgery (OR 1.003, 95% CI 1.002–1.004; p < 0.001), history of DVT (OR 1.697, 95% CI 1.038–2.776; p = 0.035), and fusion surgery (OR 1.917, 95% CI 1.356–2.709; p < 0.001) predicted selection for chemoprophylaxis. Chemoprophylaxis patients experienced more VTEs (3.62% vs 2.03% of patients, respectively; p < 0.001), and also required longer hospital stays (5.0 days vs 1.0 days; HR 0.5107; p < 0.0001) and had a greater time to the occurrence of VTE (median 6.8 days vs 3.6 days; HR 0.6847; p = 0.0003). The cumulative incidence of VTEs correlated with the postoperative day in both groups (Spearman r = 0.9746, 95% CI 0.9457–0.9883, and p < 0.0001 for the chemoprophylaxis group; Spearman r = 0.9061, 95% CI 0.8065–0.9557, and p < 0.0001 for the nonchemoprophylaxis group), and the cumulative incidence of VTEs was higher in the nonchemoprophylaxis group throughout the 30-day postoperative period. Cumulative VTE incidence and postoperative day were linearly correlated in the first 2 postoperative weeks (R = 0.9396 and p < 0.0001 for the chemoprophylaxis group; R = 0.8190 and p = 0.0003 for the nonchemoprophylaxis group) and the remainder of the 30-day postoperative period (R = 0.9535 and p < 0.0001 for the chemoprophylaxis group; R = 0.6562 and p = 0.0058 for the nonchemoprophylaxis group), but the linear relationships differ between these 2 postoperative periods (p < 0.0001 for both groups).CONCLUSIONSAnticoagulation reduces the cumulative incidence of VTE after spine surgery. The cumulative incidence of VTEs rises linearly in the first 2 postoperative weeks and then plateaus. Surgeons should consider early initiation of chemoprophylaxis for patients undergoing spine surgery.

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Meta-Regression Analysis to Indirectly Compare Prophylaxis With Dalteparin or Enoxaparin in Patients at High Risk for Venous Thromboembolic Events

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029611426869 ◽

2012 ◽

Vol 18 (3) ◽

pp. 233-242 ◽

Cited By ~ 7

Author(s):

George Dranitsaris ◽

Valentina Jelincic ◽

Yoonhee Choe

Keyword(s):

Regression Analysis ◽

High Risk ◽

Thromboembolic Events ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Meta Regression ◽

Meta Regression Analysis

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Incidence and Risk Factors for Postoperative Venous Thromboembolic Events in Patients Undergoing Cervical Spine Surgery

Clinical Spine Surgery ◽

10.1097/bsd.0000000000001140 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Annelise Bui ◽

Nassim Lashkari ◽

Blake Formanek ◽

Jeffrey C. Wang ◽

Zorica Buser ◽

...

Keyword(s):

Risk Factors ◽

Cervical Spine ◽

Spine Surgery ◽

Thromboembolic Events ◽

Cervical Spine Surgery ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic

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Evaluating the efficiency of thrombodynamics test in the diagnosis of hemostatic system disorders in gynecologic surgical patients at high risk for venous thromboembolic events

Rossiiskii vestnik akushera-ginekologa ◽

10.17116/rosakush201717565-70 ◽

2017 ◽

Vol 17 (5) ◽

pp. 65

Author(s):

S. N. Buyanova ◽

T. S. Budykina ◽

V. A. Sibryaeva ◽

T. A. Vuimo ◽

T. V. Stotskaya ◽

...

Keyword(s):

High Risk ◽

Surgical Patients ◽

Thromboembolic Events ◽

Hemostatic System ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic

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Predictors of Venous Thromboembolic Events Associated with Central Venous Port Insertion in Cancer Patients

Journal of Oncology ◽

10.1155/2014/743181 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 15

Author(s):

Christine Hohl Moinat ◽

Daniel Périard ◽

Adrienne Grueber ◽

Daniel Hayoz ◽

Jean-Luc Magnin ◽

...

Keyword(s):

Cohort Study ◽

High Risk ◽

Venous Thrombosis ◽

Cancer Patients ◽

Thromboembolic Events ◽

Central Venous ◽

Central Venous Port ◽

Venous Port ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic

Insertion of central venous port (CVP) catheter in the cancer population is associated with increased incidence of venous thromboembolic events (VTE). However, trials have shown limited benefit of antithrombotic treatment to prevent catheter-related venous thrombosis. This prospective observational cohort study was designed to assess the incidence of VTE closely related to CVP implantation in patients with cancer and undergoing chemotherapy, and to identify a high risk subgroup of patients. Between February 2006 and December 2011, 1097 consecutive cancer patients with first CVP implantation were included. Catheter-related VTE were defined as deep venous thrombosis in the arm, with or without pulmonary embolism (PE), or isolated PE. The incidence of CVP-associated VTE was 5.9% (IC95 4.4–7.3%) at 3 months, and 11.3% (IC95 9.4–13.2%) at 12 months. The incidence of any VTE was 7.6% (IC95 6.0–9.3%) at 3 months, and 15.3% (IC95 13.1–17.6%) at 12 months. High Khorana risk score and lung cancer were significant predictors of 3 month VTE. In conclusion, this large cohort study of patients with first CVP catheter implantation confirms the high incidence of VTE associated with the CVP implantation and allow identifying high risk patients who may benefit from thromboprophylaxis.

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Risk Factors for Postoperative Venous Thromboembolic Events in Patients Undergoing Lumbar Spine Surgery

Global Spine Journal ◽

10.1177/2192568218797094 ◽

2018 ◽

Vol 9 (4) ◽

pp. 409-416 ◽

Cited By ~ 2

Author(s):

Alexander Nazareth ◽

Anthony D’Oro ◽

John C. Liu ◽

Kyle Schoell ◽

Patrick Heindel ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Thromboembolic Events ◽

Lumbar Surgery ◽

Factors Associated ◽

Patient Demographics ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic

Study Design: Retrospective, database study. Objectives: The aim of this study was to investigate incidence and risk factors associated with venous thromboembolic events (VTEs) after lumbar spine surgery. Methods: Patients who underwent lumbar surgery between 2007 and 2014 were identified using the Humana within PearlDiver database. ICD-9 (International Classification of Diseases Ninth Revision) diagnosis codes were used to search for the incidence of VTEs among surgery types, patient demographics and comorbidities. Complications including DVT and PE were queried each day from the day of surgery to postoperative day 7 and for periods 0 to 1 week, 0 to 1 month, 0 to 2 months, and 0 to 3 months postoperatively. Results: A total of 64 892 patients within the Humana insurance database received lumbar surgery between 2007 and 2014. Overall VTE rate was 0.9% at 1 week, 1.8% at 1 month, and 2.6% at 3 months postoperatively. Among patients that developed a VTE within 1 week postoperatively, 45.3% had a VTE on the day of surgery. Patients with 1 or more identified risk factors had a VTE incidence of 2.73%, compared with 0.95% for patients without risk factors ( P < .001). Risk factors associated with the highest VTE incidence and odds ratios (ORs) were primary coagulation disorder (10.01%, OR 4.33), extremity paralysis (7.49%, OR 2.96), central venous line (6.70%, OR 2.87), and varicose veins (6.51%, OR 2.58). Conclusions: This study identified several patient comorbidities that were independent predictors of postoperative VTE occurrence after lumbar surgery. Clinical VTE risk assessment may improve with increased focus toward patient comorbidities rather than surgery type or patient demographics.

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