Key result
Interruption of DOAC or VKA therapy prior to spinal surgery did not significantly increase the risk of periprocedural complications compared to patients without baseline anticoagulation (OR 2.7).
Why the study?
There are no clear guidelines on the optimal timing for interrupting anticoagulation in spinal surgery.
Does interrupting antithrombotic therapy impact early periprocedural safety in patients undergoing spinal surgery?
Cohort (n=217)
No
Does interrupting antithrombotic therapy impact early periprocedural safety in patients undergoing spinal surgery?
Odds Ratio: 2.7 (95% CI 0.52–13.4)
Absolute Event Rate: 25% vs 10.5%
p-value: p=0.24
Interrupting antithrombotic therapy prior to spinal surgery according to standard protocols does not significantly increase the risk of periprocedural bleeding or thromboembolic events compared to patients not on antithrombotic therapy.
Interrupting antithrombotic therapy for spinal surgery was not linked to excess early events in elderly patients; leaves open optimal timing via prospective trials.
Objective Antithrombotic therapy is common in older patients to avoid thromboembolic events. Careful planning is required, particularly in the perioperative environment. There are no clearly date guidelines on the best timing for interrupting the use of anticoagulation in the case of spinal surgery. This study evaluates early per procedural clinical outcomes in patients whose antithrombotic therapy was interrupted for spinal surgery. Methods This is a retrospective cohort study. All patients who underwent dorsal instrumentation from January 1, 2019 to December 31, 2020 were included. In group A, vitamin K antagonists (VKA) were suspended for 5 days and direct oral anticoagulants (DOAC) for 3 days. In group B, antiplatelet agents (APA) were paused for at least 7 days before surgery to prevent perioperative bleeding. Patients not taking anticoagulation medication were gathered into control group C. We analyzed demographic data, ASA status, blood loss, comorbidities, duration of surgery, blood transfusion, length of hospital stay, complications, thromboembolism, and 30 day in-hospital mortality. Multivariate analyses from the three groups were further analyzed and conducted. Results A total of 217 patients were operated and included. Twenty-eight patients taking VKA/DOAC (group A), 37 patients using APA (group B), and 152 patients without anticoagulation (group C) underwent spinal surgery. Those using anticoagulants were significantly older and often with multimorbidity, but did not differ significantly in procedural bleeding, time of surgery, length of hospital stay, complication rate, thromboembolism, or 30 day in-hospital mortality ( p > 0.05). Conclusion Our data show that dorsal instrumentation safely took place in patients whose antithrombotic therapy was interrupted.
No takes yet. Share an insight, caveat, or question.
Banat et al. (2022) conducted a cohort in Spinal disorders requiring complex dorsal instrumentation (n=217). Interruption of DOAC or VKA therapy vs. No anticoagulation was evaluated on Any relevant complications (internal and/or surgical problems) (OR 2.7, 95% CI 0.52-13.4, p=0.24). Interruption of DOAC or VKA therapy prior to spinal surgery did not significantly increase the risk of periprocedural complications compared to patients without baseline anticoagulation (OR 2.7).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: