Postoperative Management of Direct Oral Anticoagulants After Elective Spine Surgery: When Can These Drugs be Safely Resumed?

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2026-10-02 DOI:10.1097/BSD.0000000000002169

Maroun Rizkallah, Elias Melhem, Pierre-Emmanuel Moreau, Stephane Wolff, Guillaume Riouallon

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引用次数: 0

Abstract

Study design: Retrospective monocentric study.

Objectives: To determine a safe interval for the resumption of DOACs based on the risk of postoperative surgical reoperation in the month following spine surgery.

Summary of background data: More patients scheduled for spine surgeries are being treated with direct oral anticoagulants (DOACs). Scientific society guidelines recommend the resumption of DOACs 2-3 days postoperatively. However, spine surgeries could be associated with an increased risk of complications warranting urgent surgical revision. Early resumption of DOACs imposes a 3-5-day delay before any possible intervention, raising challenges for the surgeon.

Methods: All patients who had spine surgery between 2006 and 2020 were included. Data on the occurrence of reoperation, age, sex, duration of surgery, surgeon's experience, year, and type of surgery were collected. The main outcome was the occurrence of reoperation and the time to reoperation.

Results: In total, 2540 patients, who underwent 3109 spine surgeries, were included. There were 260 reoperations that occurred in the month following the index surgery, of which 230 (7.39%) were due to complications requiring urgent revision surgery. More than 80% of the revision surgeries occurred within the 15 days following the index surgery, with half occurring after postoperative day 5. A longer duration of the surgery, nighttime surgery, and the type of surgery (multilevel fusions, surgery for surgical site infection) were associated with a significantly increased risk of revision within the month following the surgery.

Conclusions: Although the resumption of DOACs 2-3 days postoperatively is safe in terms of bleeding risk, we believe that this interval is short considering the risk of revision during the first month after surgery. Timing of DOACs' resumption should be tailored to the patient's comorbidities and to the surgical characteristics; it should sometimes involve a multidisciplinary discussion.

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择期脊柱手术后直接口服抗凝药物的术后管理：何时可以安全地恢复使用这些药物？

研究设计：回顾性单中心研究。目的：根据脊柱手术后一个月内再次手术的风险，确定doac恢复的安全间隔。背景资料总结：越来越多的脊柱手术患者正在接受直接口服抗凝剂（DOACs）治疗。科学学会指南建议术后2-3天恢复doac。然而，脊柱手术可能会增加并发症的风险，需要紧急手术翻修。早期恢复doac会导致任何可能的干预措施延迟3-5天，这给外科医生带来了挑战。方法：纳入2006年至2020年间所有脊柱手术患者。收集再手术的发生率、年龄、性别、手术时间、外科医生经验、年份和手术类型等数据。主要观察指标为再手术发生率和再手术时间。结果：共纳入2540例患者，3109例脊柱手术。指数手术后一个月内再手术260例，其中230例（7.39%）因并发症需要紧急翻修手术。超过80%的翻修手术发生在指数手术后15天内，其中一半发生在术后第5天之后。较长的手术时间、夜间手术和手术类型（多节段融合、手术部位感染）与术后一个月内翻修风险显著增加相关。结论：虽然从出血风险来看，术后2-3天恢复DOACs是安全的，但考虑到术后第一个月翻修的风险，我们认为这个时间间隔很短。doac恢复的时间应根据患者的合并症和手术特点进行调整；它有时应该涉及多学科的讨论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.