gms | German Medical Science

Objective: Anticoagulation therapy (AC) after treatment of spinal dural arteriovenous fistula (SDAVF) is well known in clinical practice but still inadequately reported in the literature. In this study, we evaluated the effectiveness and safety of postoperative AC in SDAVF patients.

Methods: We retrospectively analyzed our medical database for patients who were treated due to SDAVF in our institution between January 2006 and February 2016. Data of overall 53 patients were included in this analysis. Microsurgical treatment was performed in all patients. Follow-up informations were gathered by telephone questionnaire. We used Aminoff-Logue disability score (AL-score) to evaluate the functional outcome at time of admission, of discharge, and of telephone survey. Follow-up data were available in 40 patients with a mean follow-up period of 53.4±36 months. We dichotomized our cohort with regard to the administration of AC as follows: a) Prophylactic group (n=11): UFH (n=7) aiming a PTT of 40-50sec, or high-dose weight-adjusted LMWH (n=4) (2x1mg/kg body weight) b) Non-prophylactic group (n=42): routine thromboembolic prophylaxis with low-dose LMWH (n=38) or therapeutic AC via UFH (n=4) aiming a PTT of 40-50 sec.

Results: In group (a) no acute deterioration was reported during the inpatient stay. In group (b) 4 of 42 patients presented an acute deterioration within the first two postoperative days (mean: 0.75, range; 0-2 days); however, the incidence of postoperative deterioration did not reach statistical significance (p=0.57). Therapeutic AC was performed in all 4 patients with acute deterioration, immediately after exclusion of hemorrhage and progressive congestive myelopathy via emergency MRI. Neurological deterioration resolved completely within few days after AC (mean 6.8±1.2 days, range: 5-8). One patient developed secondary aggravation of his paraparesis two days after termination of postoperative AC, which in turn resolved completely after re-starting AC. At time of discharge, all four patients presented an unchanged neurological status compared with the pretreatment status. No clinical AC related complications were observed in either group. Neurological status did not differ significantly between both groups at time of admission (p=0.093), of discharge (p=0.723) and of last follow-up (p=0.222).

Conclusion: Acute deterioration after treatment of SDAVF is a rare complication and was present in overall 7% of patients in our series. Even though the sample size is small to draw a definite conclusion, our findings imply that AC could be effective and safe to treat acute postoperative deterioration in SDAVF patients. In these cases, AC might reinforce the venous microcirculation and outflow of the spinal cord. Prophylactic postoperative AC may be considered to decrease the incidence of postoperative deterioration though an influence on outcome was not observed.