Article
Post-operative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery
Die postoperative Tromboembolieprophylaxe mit Nadroparin nach spinalen Operationen ist nicht mit einem erhöhten Nachblutungsrisiko assoziiert
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Authors
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Rüdiger Gerlach
- Klinik für Neurochirurige, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
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A. Raabe
- Klinik für Neurochirurige, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
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V. Seifert
- Klinik für Neurochirurige, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
| Published: | April 23, 2004 |
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Outline
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Objective
To determine the risk of post-operative hemorrhage during a 3-year period of early postoperative administration of nadroparin (Fraxiparin®), plus compression stockings in a large cohort of patients who underwent spinal surgery.
Methods
A total of 1,954 spinal procedures at different levels (503 cervical, 152 thoracic and 1299 lumbar), performed between June 1999 and 2002 were included in this study. To prevent venous thromboembolic events (VTE) all patients were routinely treated subcutaneously with early (less than 24 hours) postoperative nadroparin calcium (Fraxiparin®) 0.3ml (2850IU anti Xa, Sanofi Winthrop Industrie, France) plus intra- and postoperative compression stockings until discharge. The occurrence of a postoperative hematoma (defined as hematoma requiring surgical evacuation, because of space occupation and/ or neurological deterioration) and a deep venous thrombosis (DVT) were recorded in a database and analyzed retrospectively.
Results
Thirteen (0.7%) of the 1954 spinal operations were complicated by major postoperative hemorrhages. In five of the 13 patients (38.5%) the hemorrhage occurred at the day of surgery before the administration of nadroparin. Thus the hemorrhage rate of patients receiving nadroparin was 0.4% (8/1949). 10 (77%) of the 13 patients with major postoperative hematoma showed a progressive neurological deficit, which resolved in 6 patients and resulted in a hematoma related morbidity of 31% (4/13). Only 1 patient (0.05%) in this series developed a clinical evident DVT and none of the patient suffered from pulmonary embolus during the hospital stay.
Conclusions
Although retrospective, this is to date the largest study providing information about the hemorrhage rate associated with early postoperative anticoagulation following spinal surgery. The results confirm that early postoperative pharmacological thromboembolic prophylaxis using nadroparin in patients with spinal surgery is not associated with an increased risk of postoperative hemorrhage.
