Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct;10(7):844-850.
doi: 10.1177/2192568219878418. Epub 2019 Sep 30.

Use of Fondaparinux Following Elective Lumbar Spine Surgery Is Associated With a Reduction in Symptomatic Venous Thromboembolism

Mitchell S Fourman  1 , Jeremy D Shaw  1 , Chinedu O Nwasike  1 , Lorraine A T Boakye  1 , Malcolm E Dombrowski  1 , Nicholas J Vaudreuil  1 , Richard A Wawrose  1 , David J Lunardini  2 , Joon Y Lee  1
Affiliations

Use of Fondaparinux Following Elective Lumbar Spine Surgery Is Associated With a Reduction in Symptomatic Venous Thromboembolism

Mitchell S Fourman et al. Global Spine J. 2020 Oct.

Abstract

Study design: Retrospective cohort study.

Objective: To assess the impact of fondaparinux on venous thromboembolism (VTE) following elective lumbar spine surgery in high-risk patients.

Methods: Matched patient cohorts who did or did not receive inpatient fondaparinux starting postoperative day 2 following elective lumbar spine surgery were compared. All patients received 1 month of acetyl salicylic acid 325 mg following discharge. The primary outcome was a symptomatic DVT (deep vein thrombosis) or PE (pulmonary embolus) within 30 days of surgery. Secondary outcomes included prolonged wound drainage, epidural hematoma, and transfusion.

Results: A significantly higher number of DVTs were diagnosed in the group that did not receive inpatient VTE prophylaxis (3/102, 2.9%) compared with the fondaparinux group (0/275, 0%, P = .02). Increased wound drainage was seen in 18.5% of patients administered fondaparinux, compared with 25.5% of untreated patients (P = .15). Deep infections were equivalent (2.2% with fondaparinux vs 4.9% control, P = .18). No epidural hematomas were noted, and the number of transfusions after postoperative day 2 and 90-day return to operating room rates were equivalent.

Conclusions: Patients receiving fondaparinux had lower rates of symptomatic DVT and PE and a favorable complication profile when compared with matched controls. The retrospective nature of this work limits the safety and efficacy claims that can be made about the use of fondaparinux to prevent VTE in elective lumbar spine surgery patients. Importantly, this work highlights the potential safety of this regimen, permitting future high-quality trials.

Keywords: adult spine; deep vein thrombosis; fondaparinux; high-risk; pulmonary embolism; venous thromboembolism prophylaxis.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Absolute and relative selection criteria for the use of fondaparinux starting on postoperative day 2.
Figure 2.
Figure 2.
Patient selection flowchart.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Kwong LM, Kimball JA. Postorthopedic surgery joint replacement surgery venous thromboembolism prophylaxis. Hematol Oncol Clin North Am. 2016;30:1007–1018. doi:10.1016/j.hoc.2016.05.001 - PubMed
    1. Yamanaka Y, Ito H. Incidence of venous thromboembolism in patients undergoing major hip surgeries at a single institution: a prospective study. Open Orthop J. 2016;10:252–257. doi:10.2174/1874325001610010252 - PMC - PubMed
    1. Zhang ZH, Shen B, Yang J, et al. Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years. BMC Musculoskelet Disord. 2015;16:24 doi:10.1186/s12891-015-0470-0 - PMC - PubMed
    1. Zhang J, Chen Z, Zheng J, Breusch SJ, Tian J. Risk factors for venous thromboembolism after total hip and total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg. 2015;135:759–772. doi:10.1007/s00402-015-2208-8 - PubMed
    1. Forster R, Stewart M. Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair. Cochrane Database Syst Rev. 2016;(3):CD004179 doi:10.1002/14651858.CD004179.pub2 - PMC - PubMed

LinkOut - more resources