Why the study?
Managing antithrombotic therapy during elective spinal surgery is challenging due to balancing bleeding and thromboembolic risks, prompting an evaluation of the quality and clarity of available clinical guidelines.
What is the methodological quality and reporting clarity of clinical practice guidelines for the use of antithrombotic therapy in elective spinal procedures?
Systematic Review (n=16)
What is the methodological quality and reporting clarity of clinical practice guidelines for the use of antithrombotic therapy in elective spinal procedures?
Current clinical practice guidelines for managing antithrombotic therapy during elective spinal procedures exhibit substantial heterogeneity in methodological quality, highlighting a need for high-quality primary data and more rigorous guideline development.
Answers are grounded in this paper and cite their sources.
Clinicians should interpret current antithrombotic guidelines for elective spine procedures with caution; challenges uniformity and extends calls for rigorous development plus primary evidence.
The perioperative management of patients medicated with antithrombotic agents who require elective spinal surgery is extremely challenging because of the increased risk of surgical bleeding and the concurrent need to minimize the thromboembolic risk. The aims of the present systematic review are to: (1) identify clinical practice guidelines (CPGs) and recommendations (CPRs) on this topic and (2) assess their methodological quality and reporting clarity. An electronic systematic search of the English Medical Literature up to January 31, 2021 was conducted using PubMed, Google Scholar, and Scopus. Two raters assessed the methodological quality and reporting clarity of the gathered CPGs and CPRs using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. The agreement between the two raters was assessed using Cohen's kappa. Of the initially gathered 38 CPGs and CPRs, 16 fulfilled our eligibility criteria and were evaluated using the AGREE II instrument. The reports published by "Narouze 2018" and "Fleisher 2014" were scored as being of "high-quality" and having an adequate interrater agreement (Cohen's kappa ≥0.60). Overall, the AGREE II domains of "clarity of presentation" and "scope and purpose" yielded the highest scores (100%), whereas the domain "stakeholder involvement" scored the lowest score (48.5%). The perioperative management of antiplatelet and anticoagulant agents in elective spine surgery may be challenging. Because of the lack of high-quality data in this field, uncertainty remains regarding the optimal practices to balance the risk of thromboembolism against that of bleeding.
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Ntalouka et al. (2023) conducted a systematic review in Patients on antithrombotic agents undergoing elective spinal procedures (n=16). Clinical practice guidelines for antithrombotic therapy was evaluated on Methodological quality and reporting clarity assessed using the AGREE II tool. A systematic review of 16 clinical practice guidelines for antithrombotic therapy in elective spinal procedures found substantial heterogeneity in methodological quality, with stakeholder involvement scoring the lowest at 48.5%.
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