Use of Fondaparinux Following Elective Lumbar Spine Surgery Is Associated With a Reduction in Symptomatic Venous Thromboembolism.

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Tytuł:: Use of Fondaparinux Following Elective Lumbar Spine Surgery Is Associated With a Reduction in Symptomatic Venous Thromboembolism.
Autorzy:: Fourman MS; 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Shaw JD; 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Nwasike CO; 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Boakye LAT; 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Dombrowski ME; 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Vaudreuil NJ; 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Wawrose RA; 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Lunardini DJ; 2090University of Vermont Medical Center, Burlington, VT, USA.
Lee JY; 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Źródło:: Global spine journal [Global Spine J] 2020 Oct; Vol. 10 (7), pp. 844-850. Date of Electronic Publication: 2019 Sep 30.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: 2017- : London : SAGE Publications
Original Publication: New York, NY : Thieme Medical Publishers
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Contributed Indexing:: Keywords: adult spine; deep vein thrombosis; fondaparinux; high-risk; pulmonary embolism; venous thromboembolism prophylaxis
Entry Date(s):: Date Created: 20200909 Latest Revision: 20220416
Update Code:: 20240105
PubMed Central ID:: PMC7485070
DOI:: 10.1177/2192568219878418
PMID:: 32905722
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Study Design: Retrospective cohort study.
Objective: To assess the impact of fondaparinux on venous thromboembolism (VTE) following elective lumbar spine surgery in high-risk patients.
Methods: Matched patient cohorts who did or did not receive inpatient fondaparinux starting postoperative day 2 following elective lumbar spine surgery were compared. All patients received 1 month of acetyl salicylic acid 325 mg following discharge. The primary outcome was a symptomatic DVT (deep vein thrombosis) or PE (pulmonary embolus) within 30 days of surgery. Secondary outcomes included prolonged wound drainage, epidural hematoma, and transfusion.
Results: A significantly higher number of DVTs were diagnosed in the group that did not receive inpatient VTE prophylaxis (3/102, 2.9%) compared with the fondaparinux group (0/275, 0%, P = .02). Increased wound drainage was seen in 18.5% of patients administered fondaparinux, compared with 25.5% of untreated patients ( P = .15). Deep infections were equivalent (2.2% with fondaparinux vs 4.9% control, P = .18). No epidural hematomas were noted, and the number of transfusions after postoperative day 2 and 90-day return to operating room rates were equivalent.
Conclusions: Patients receiving fondaparinux had lower rates of symptomatic DVT and PE and a favorable complication profile when compared with matched controls. The retrospective nature of this work limits the safety and efficacy claims that can be made about the use of fondaparinux to prevent VTE in elective lumbar spine surgery patients. Importantly, this work highlights the potential safety of this regimen, permitting future high-quality trials.

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