Risk of venous thromboembolism and bleeding complications for early enoxaparin versus heparin after same-day spine surgery for central cord syndrome: A propensity-matched retrospective cohort study.

Abstract

Study design: Retrospective cohort study.

Objective: The primary purpose of this study is to compare the effect of enoxaparin versus heparin on the risk of venous thromboembolism (VTE) after early spine surgery for CCS, hypothesizing no difference in risk.

Setting: Multi-site academic centers.

Methods: This retrospective propensity-matched cohort study using the TriNetX database included adults (≥18 years) who underwent same-day spine surgery for CCS; divided into cohorts depending on the administration of heparin or enoxaparin within three days after surgery (heparin cohort or enoxaparin cohort, respectively). The primary outcome was the incidence and risk ratio (RR) of VTE with secondary outcomes of the incidence and RR of epidural hematoma (EDH), deep venous thrombosis (DVT), and severe postoperative bleeding (SPOB). Cohorts were matched by multiple confounding variables.

Results: There were 1,089 patients (mean age: 59 years; 71% male) in each cohort. Comparing the enoxaparin to heparin cohort through three months after surgery, there was no statistically significant or clinically meaningful difference in risk of VTE (P = 0.607; RR:1.11). There were 52 cases (4.8%) and 47 cases (4.3%) of VTE in the enoxaparin and heparin cohorts, respectively. The median time from surgery to VTE was 14.1 and 12.8 days in the enoxaparin and heparin cohorts, respectively. There was no statistically significant difference in risk of EDH (P = 0.693), DVT (P = 0.677), or SPOB (P = 0.861) between both cohorts.

Conclusion: Incidence of VTE through three months after same-day spine surgery for CCS was consistent with the literature, without increased risk of VTE based on the administration of early enoxaparin versus heparin.