Sistema Ortopédico e Muscular: Pesquisa Atual
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A Prospective, Active-control, Non-inferiority Study of the Effectiveness of Low Molecular Weight Heparin in the Prophylaxis of Postoperative Thrombotic Events in Patients Undergoing Spinal Surgery

Lunzer Andreas*, Vavken Patrick, Grohs Josef Georg

Background: The Incidence of verified thrombotic events after elective spine surgery is 18%. Low-Molecular- Weight-Heparin (LMWH) is routinely given on the day before surgery. A postoperative start of the thrombotic prophylaxis could be an advantage in cases with opening of the spinal canal and for preventing epidural bleeding.
Patient and methods: This active-controlled non-inferiority trial compared the effectiveness and safety of LMWH started pre- or postoperatively in patients undergoing spinal surgery. We analysed the incidence of clinically symptomatic venous thromboembolism.
Results: A total number of 241 patients were followed over 14.6 patient-years. The incidence risk of fatal thromboembolisms was 0.011 (95%CI 0.0003 to 0.06) for the group with preoperative treatment and 0.01 (95% CI 0.0002 to 0.04) for the postoperatively treated group. The crude risk ratio was 1.65 (95%CI 0.10 to 26.03). There was no statistically significant difference in risk across groups (p=0.72). The Poisson regression model including follow-up time showed an incidence rate ratio of 0.67 (95% 0.04 to 10.74, p=0.779). There was no increased risk for complications (p=0.211).
Conclusion: This study demonstrates that the postoperative start of LMWH in the prophylaxis of thrombotic events in patients undergoing spinal surgery does not affect safety or the incidence of complications.