DVT Prophylaxis in Spine Surgery: Targeted Strategies and Outcomes

Background Although uncommon, the deep venous thrombosis (DVT) and pulmonary embolism (PE) are serious complications of spine surgery that worsen patient outcomes. Prophylactic measures to prevent the formation of DVT have been explored in spine surgery but given the multitude of potential prophylactic methods and agents, a comprehensive review and understanding of prophylactic agents and their indications is essential. Objective Conduct a review of the major DVT prophylactic agents used in spine surgery to provide a cohesive review on the indications, benefits, and drawbacks of commonly used DVT prophylactic agents. Methods A literature review on DVT prophylaxis in spine surgery was conducted, with high strength, Levels I and II, and evidence being prioritized, where patient outcomes and complications from prophylactic measures were quantified. Results The rates of DVT and PE from spine surgery can vary based on procedure with fusion surgeries, especially multi-level fusion surgeries, anterior approach surgeries, and trauma spine surgeries having greater rates of DVT. Mechanical prophylaxis was found to have reasonable efficacy with minimal drawbacks but may potentially not be strong enough for DVT prophylaxis in higher risk patients. Chemoprophylaxis when indicated is best done with low molecular weight heparin (LMWH) or direct factor X inhibitors (DFXIs). Determination of need for chemoprophylaxis should be done on a patient-by-patient basis. When indicated, DVT chemoprophylaxis should be initiated in the first 48 hours postoperation to maximize effectiveness and safety. Conclusion DVT prophylaxis is critical for spine surgery patients to improve patient outcomes. Determining what style of DVT prophylaxis will be most effective for a patient can ensure that patients are able to recover from surgery quicker and safer.