Key result
Urgent spine revision surgery occurs in ~7% of patients within 1 month, challenging early DOAC resumption.
Why the study?
Scientific society guidelines recommend resuming DOACs 2-3 days after spine surgery, but the risk of postoperative surgical reoperation timing is uncertain.
What is the incidence and timing of urgent surgical revision after elective spine surgery to guide the safe postoperative resumption of DOACs?
Observational (n=2,540)
No
What is the incidence and timing of urgent surgical revision after elective spine surgery to guide the safe postoperative resumption of DOACs?
More than 80% of urgent revision surgeries after spine surgery occur within 15 days, suggesting that routine resumption of DOACs at 2-3 days postoperatively may pose challenges if reoperation is required.
May challenge early DOAC resumption guidelines after spine surgery; leaves open optimal timing pending randomized data.
STUDY DESIGN: Retrospective monocentric study. OBJECTIVES: To determine a safe interval for the resumption of DOACs based on the risk of postoperative surgical reoperation in the month following spine surgery. SUMMARY OF BACKGROUND DATA: More patients scheduled for spine surgeries are being treated with direct oral anticoagulants (DOACs). Scientific society guidelines recommend the resumption of DOACs 2-3 days postoperatively. However, spine surgeries could be associated with an increased risk of complications warranting urgent surgical revision. Early resumption of DOACs imposes a 3-5-day delay before any possible intervention, raising challenges for the surgeon. METHODS: All patients who had spine surgery between 2006 and 2020 were included. Data on the occurrence of reoperation, age, sex, duration of surgery, surgeon's experience, year, and type of surgery were collected. The main outcome was the occurrence of reoperation and the time to reoperation. RESULTS: In total, 2540 patients, who underwent 3109 spine surgeries, were included. There were 260 reoperations that occurred in the month following the index surgery, of which 230 (7.39%) were due to complications requiring urgent revision surgery. More than 80% of the revision surgeries occurred within the 15 days following the index surgery, with half occurring after postoperative day 5. A longer duration of the surgery, nighttime surgery, and the type of surgery (multilevel fusions, surgery for surgical site infection) were associated with a significantly increased risk of revision within the month following the surgery. CONCLUSIONS: Although the resumption of DOACs 2-3 days postoperatively is safe in terms of bleeding risk, we believe that this interval is short considering the risk of revision during the first month after surgery. Timing of DOACs' resumption should be tailored to the patient's comorbidities and to the surgical characteristics; it should sometimes involve a multidisciplinary discussion.
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Rizkallah et al. (2026) conducted an observational in Spine surgery (n=2,540). Spine surgery was evaluated on Occurrence of reoperation and the time to reoperation in the month following index surgery. Urgent revision surgery within 1 month was required in 7.39% of 3,109 spine surgeries, with over 80% occurring within 15 days, challenging routine early DOAC resumption.
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