Does the choice of chemoprophylaxis affect the prevention of deep vein thrombosis in lumbar fusion surgery? A systematic review of the literature

Sathish Muthu; Georgios Mavrovounis; Stipe Corluka; Zorica Buser; Giovanni Barbanti Brodano; Yabin Wu; Hans-Jorg Meisel; Jeffrey Wang; S Tim Yoon; Andreas K Demetriades; AO Spine Knowledge Forum Degenerative

doi:10.1016/j.bas.2023.102711

Does the choice of chemoprophylaxis affect the prevention of deep vein thrombosis in lumbar fusion surgery? A systematic review of the literature

Brain Spine. 2023 Nov 14:3:102711. doi: 10.1016/j.bas.2023.102711. eCollection 2023.

Authors

Sathish Muthu^{1

2

3}, Georgios Mavrovounis⁴, Stipe Corluka^{5

6

7}, Zorica Buser^{8

9}, Giovanni Barbanti Brodano¹⁰, Yabin Wu¹¹, Hans-Jorg Meisel¹², Jeffrey Wang¹³, S Tim Yoon¹⁴, Andreas K Demetriades¹⁵; AO Spine Knowledge Forum Degenerative

Affiliations

¹ Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, Tamil Nadu, India.
² Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India.
³ Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India.
⁴ Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larissa, Greece.
⁵ Spinal surgery Division, Department of Traumatology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia.
⁶ Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia.
⁷ St. Catherine Specialty Hospital, Zagreb, Croatia.
⁸ Gerling Institute, Brooklyn, NY, USA.
⁹ Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA.
¹⁰ IRCCS Istituto Ortopedico Rizzoli, Bologna, IT, Italy.
¹¹ Research Department, AO Spine International, Davos, Switzerland.
¹² BG Klinikum Bergmannstrost Halle, Germany.
¹³ Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, CA, USA.
¹⁴ Department of Orthopaedics, Emory University, Atlanta, GA, USA.
¹⁵ Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Royal Infirmary Edinburgh, UK.

Abstract

Introduction: To date, the available guidance on venous thromboembolism (VTE) prevention in elective lumbar fusion surgery is largely open to surgeon interpretation and preference without any specific suggested chemoprophylactic regimen.

Research question: This study aimed to comparatively analyze the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) with the use of commonly employed chemoprophylactic agents such as unfractionated heparin (UH) and low molecular weight heparin (LMWH) in lumbar fusion surgery.

Material and methods: An independent systematic review of four scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed to identify relevant articles as per the preferred reporting in systematic reviews and meta-analysis (PRISMA) guidelines. Studies reporting on DVT/PE outcomes of lumbar fusion surgery in adult patients with UH or LMWH chemoprophylaxis were included for analysis. Analysis was performed using the Stata software.

Results: Twelve studies with 8495 patients were included in the analysis. A single-arm meta-analysis of the included studies found a DVT incidence of 14% (95%CI [8%-20%]) and 1% (95%CI [-6% - 8%]) with LMWH and UH respectively. Both the chemoprophylaxis agents prevented PE with a noted incidence of 0% (95%CI [0%-0.1%]) and 0% (95%CI [0%-1%]) with LMWH and UH respectively. The risk of bleeding-related complications with the usage of LMWH and UH was 0% (95% CI [0.0%-0.30%]) and 3% (95% CI [0.3%-5%]) respectively.

Discussion and conclusion: Both LMWH and UH reduces the overall incidence of DVT/PE, but there is a paucity of evidence analyzing the comparative effectiveness of the chemoprophylaxis regimens in lumbar fusion procedures. The heterogeneity in data prevents any conclusions, as there remains an evidence gap. We recommend future high-quality randomized controlled trials to investigate in this regard to help develop recommendations on thromboprophylaxis usage.

Keywords: Chemoprophylaxis; Deep vein thrombosis; Heparin; LMWH; Low-molecular-weight heparin; Lumbar fusion; Pulmonary embolism.

Publication types

Review