gms | German Medical Science

Objective: Patients undergoing spinal surgery under anticoagulation at the day of surgery are at risk of developing bleeding complications even though lower incidences have been reported as compared to joint arthroplasty surgery. There exists a gap in the medical literature examining the incidence of postoperative spinal bleeding by patients who were under anticoagulation at the time of surgery.

Method: We prospectively followed a consecutive cohort of 100 patients undergoing spinal surgery. The average patient age was 48.7 years and the minimum follow-up time was 12 months. Diagnosis was lumbar spinal stenosis in 20, herniated lumbar discs in 63, degenerative cervical disc disease in 3 and cervical disc herniation in 14 cases. All patients had a cardiovascular disease not allowing to stop anticoagulants (acetylsalicylic acid or clopidogrel) in the peri- and postoperative period.

Results: None of the patients suffered any postoperative bleeding complication. Three patients suffered postoperative wound dehiscence and one patient had an infection that required re-operation. 63 patients were on clopidogrel and 37 on acetylsalicylic acid.

Conclusions: Spinal operations vary tremendously in terms of complexity, length of time under anesthetic, levels decompressed and fused, and surgical approach (anterior/posterior/combined approaches) depending on the pathology being treated. The question whether the pre-operative low-dose acetylsalicylic acid medication has to be stopped before elective spinal surgery has never been answered in the literature. For clopidogrel, which was more recently introduced in cardiovascular therapy, no data exist. In our prospective series we have found no increase in the risk of postoperative spinal bleeding with the use of clopidogrel or acetylsalicylic acid. This finding suggests that spine surgery can be done without stopping anticoagulation. Large multicenter prospective randomized studies are needed to fully investigate the associated risks and consequences of anticoagulation therapy after spinal surgery. Lacking specific guidelines, each patient should be treated on an individual basis, and the potential benefits of anticoagulation should be compared with the potential risks (risk-benefit ratio).