Venous Thromboembolism Chemoprophylaxis Within 24 Hours of Surgery for Spinal Cord Injury: Is It Safe and Effective?

Seth Ahlquist; Howard Y. Park; Benjamin Kelley; Langston Holly; Ayra N. Shamie; Don Y. Park

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자료유형: 학술저널

저자정보: Seth Ahlquist (David Geffen School of Medicine at UCLA) Howard Y. Park (David Geffen School of Medicine at UCLA) Benjamin Kelley (David Geffen School of Medicine at UCLA) Langston Holly (David Geffen School of Medicine at UCLA) Ayra N. Shamie (David Geffen School of Medicine at UCLA) Don Y. Park (David Geffen School of Medicine at UCLA)

저널정보: 대한척추신경외과학회 Neurospine 대한척추신경외과학회지 제17권 제2호

발행연도: 2020.1

수록면: 407 - 416 (10page)

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Objective: Current guidelines recommend initiation of venous thromboembolism (VTE) chemoprophylaxis within 72 hours of spinal cord injury (SCI). This study investigated the safety and efficacy of chemoprophylaxis within 24 hours of surgery for SCI. Methods: A retrospective review of 97 consecutive patients who underwent surgery for acute traumatic SCI at a single level 1 trauma center from 2013–2018 was performed. VTE/ postoperative bleeding rates during hospitalization, demographics, medical/surgical complications, drain output, length of stay, and disposition were obtained. Chi–square with odds ratios (ORs), 1-way analysis of variance, and logistic regression were performed to establish significant differences between groups. Results: Seventy–nine patients were included, 49 received chemoprophylaxis within 24 hours and 20 within 24–72 hours. Cohort characteristics included an average age of 51.8 years, 77.2% male, 62.0% cervical, and 35.4% thoracic SCIs. Using the American Spinal Injury Association Impairment Scale (AIS), 39.2% were AIS-A injuries, 19.0% AIS-B, 25.3% AIS-C, and 16.5% AIS-D. Unfractionated heparin was administered in 88.6% of patients and 11.4% received low molecular weight heparin. Chemoprophylaxis within 24 hours of surgery was associated with a lower rate of VTE (6.1% vs. 35.0%; OR, 0.121; 95% confidence interval [CI], 0.027–0.535) and deep vein thrombosis (4.1% vs. 30.0%; OR, 0.099; 95% CI, 0.018–0.548) versus 24–72 hours. Pulmonary embolism rates were not significantly different (6.1% vs. 5.0%, p = 1.0). There were no postoperative bleeding complications and no significant difference in drain output between cohorts. Conclusion: Early VTE chemoprophylaxis is effective with lower VTE rates when initiated within 24 hours of surgery for SCI and is safe with no observed postoperative bleeding complications.

#Spinal cord injuries #Venous thromboembolism #Heparin #Low molecular wei�ght #Pulmonary embolism

참고문헌 (39)

참고문헌 신청

National Spinal Cord Injury Statistical Center / Spinal cord injury facts and figures at a glance

Geerts WH / 1994 / A prospective study of venous thromboembolism after major trauma / N Engl J Med 331:1601~1606

Alabed S / 2015 / Incidence of pulmonary embolism after the first 3 months of spinal cord injury / Spinal Cord 53:835~837

Samer Alabed / 2016 / Thromboembolism in the Sub-Acute Phase of Spinal Cord Injury: A Systematic Review of the Literature / Asian Spine Journal 10(5):972~981

Eichinger S / 2018 / Risk of venous thromboembolism during rehabilitation of patients with spinal cord injury / PLoS One 13:e0193735

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