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
Review
. 2022 Mar 1;35(2):63-75.
doi: 10.1097/BSD.0000000000001260.

Narrative Review of Antiplatelet and Anticoagulant Medications for Venous Thromboembolism Prevention in Spine Surgery

Philip K Louie  1 , Hikari Urakawa  1 , Mustfa K Manzur  2 , Chad M Craig  1   3 , Sheeraz A Qureshi  1   3
Affiliations
Review

Narrative Review of Antiplatelet and Anticoagulant Medications for Venous Thromboembolism Prevention in Spine Surgery

Philip K Louie et al. Clin Spine Surg. .

Abstract

Study design: This was a narrative review.

Objective: The objective of this study was to identify commonly utilized venous thromboembolism (VTE) prophylactic measures, spine surgeon perspective, and provide pharmacologic recommendations from the literature.

Summary of background data: Considered a preventable cause of morbidity and mortality, VTE remains an important iatrogenic diagnosis of concern. Reported rates of VTE following spine surgery vary widely (0.3%-31.0%).

Materials and methods: A MEDLINE query identified literature reporting on VTE prevention and outcomes in the setting of spine surgery. Findings extracted from the included articles were summarized in a narrative review format to identify salient aspects of the current literature.

Results: Sixty articles were summarized. Many anticoagulation medications that are described in the literature target factors involved in the coagulation cascade common pathway including aspirin and other antiplatelet medications, heparins, and warfarin. Newer direct inhibitors of thrombin and factor Xa are now being utilized for VTE prevention, although with limited use specifically in spine surgery.

Conclusions: Perioperative management of antiplatelet and anticoagulation medications in spine surgery requires evidence-based protocols that can account for patient comorbidities and surgery-specific features. Future studies should prospectively focus on establishing stronger recommendations based on pathology, surgical indications, patient comorbidities, region of the spine, and broad surgical intervention to enable effective prophylaxis for VTE.

Level of evidence: Level II.

PubMed Disclaimer

Conflict of interest statement

S.A.Q.: has been a consultant for Paradigm Spine, Globus Medical Inc., and Stryker K2M; receives royalties from Globus Medical Inc., Stryker K2M; has ownership interest in Avaz Surgical, Vital 5 (past relationship); has served on the scientific advisory board/other office for the Association of Bone and Joint Surgeons, Cervical Spine Research, Contemporary Spine Surgery, Healthgrades, International Society for the Advancement of Spine Surgery, LifeLink.com Inc., Minimally Invasive Spine Surgery Group, Minimally Invasive Spine Study Group, North American Spine Society, Simplify Medical Inc., Society of Minimally Invasive Spine Surgery, Spinal Simplicity LLC; has served on the editorial board of the Annals of Translational Medicine, Global Spine Journal, Journal of American Academy of Orthopaedic Surgeons, Spine, The Spine Journal; has received honoraria from AMOpportunities, RTI Surgical Inc.; and has received speakers fees from Globus Medical Inc. The remaining authors declare no conflict of interest.

References

    1. Akeda K, Matsunaga H, Imanishi T, et al. Prevalence and countermeasures for venous thromboembolic diseases associated with spinal surgery: a follow-up study of an institutional protocol in 209 patients. Spine. 2014;39:791–797.
    1. Hohl JB, Lee JY, Rayappa SP, et al. Prevalence of venous thromboembolic events after elective major thoracolumbar degenerative spine surgery. J Spinal Disord Tech. 2015;28:E310–E315.
    1. Schairer WW, Pedtke AC, Hu SS. Venous thromboembolism after spine surgery. Spine. 2014;39:911–918.
    1. Goz V, McCarthy I, Weinreb JH, et al. Venous thromboembolic events after spinal fusion: which patients are at high risk? J Bone Joint Surg Am. 2014;96:936–942.
    1. Piasecki DP, Poynton AR, Mintz DN, et al. Thromboembolic disease after combined anterior/posterior reconstruction for adult spinal deformity: a prospective cohort study using magnetic resonance venography. Spine. 2008;33:668–672.

MeSH terms

LinkOut - more resources