33. 低分子肝素预防在分期胸腰椎融合患者中是安全的

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100727

Harsh Wadhwa MD , Jayme Koltsov PhD , Serena S Hu MD

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引用次数: 0

摘要

背景背景更长时间的胸腰椎融合有时是分阶段进行的，这有更高的深静脉血栓形成（DVT）和肺栓塞（PE）的风险。低分子肝素（LMWH）预防可以改善这些风险。目的评估接受或未接受低分子肝素分期和未分期胸腰椎融合的患者DVT和PE的发生率。研究设计/设置：回顾性队列研究。患者样本：接受5节段胸腰椎融合的成人（2014-2024年单一机构）。观察结果：90天并发症、再入院和再手术。方法收集患者人口统计学、合并症、围手术期数据（EBL、输血等）和术后数据（90天并发症、再入院、再手术）。对分期和未分期患者分别进行分析，通过卡方检验和Fisher精确检验评估低分子肝素的差异（a=0.05）。结果共纳入191例分期患者（女性131例（68.6%），66.7±9.2岁）和216例未分期患者（女性146例（67.6%），67.7±9.8岁）。分阶段手术133例（70%）给予低分子肝素，非分阶段手术107例（50%）给予低分子肝素。在分期患者中，低分子肝素组PE发生率为3.1% (95% CI 1.2, 7.8)，非低分子肝素组为9.1% (4.0,19.6)(p=0.132)；低分子肝素组DVT发生率为4.7%(2.2,9.9)，非低分子肝素组为5.5% (1.9,14.9)（p>0.999）。接受低分子肝素治疗的患者BMI较高（29.1 [28.2,30.1]vs 27.0 [25.7, 28.2], p=0.011）。未分期患者中，低分子肝素组PE发生率为3.9%(1.5,9.6)，无低分子肝素组为3.1% (1.1,8.8)(p=0.185)；低分子肝素组DVT发生率为2.9%(1.0,8.2)，无低分子肝素组为4.2% (1.6,10.2)（p=0.338）。在分期和未分期的队列中，输血率（和输血量）与没有低分子肝素的队列相当(分期：96.4% [87.7,99.0]vs 92.1% [86.1, 95.7], [p=0.352]；Unstaged: 73.8% vs 76.0% [64.6, 81.3] [66.6, 83.5], p = 0.387)。并发症、再入院和6个月再手术也与没有低分子肝素的患者相当。结论：在迄今为止最大的一项研究中，直接比较了长胸腰椎融合与不预防低分子肝素，低分子肝素没有增加出血或输血。低分子肝素可能有好处，特别是在PE减少方面；然而，需要大规模的基于人群的研究来证实。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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33. Low molecular weight heparin prophylaxis is safe in patients undergoing staged thoracolumbar fusion

BACKGROUND CONTEXT

Longer thoracolumbar fusions are sometimes performed in a staged approach, which carries higher deep vein thrombosis (DVT) and pulmonary embolism (PE) risks. Low molecular weight heparin (LMWH) prophylaxis may ameliorate these risks.

PURPOSE

To assess rates of DVT and PE among patients who did or did not receive LMWH undergoing staged and unstaged thoracolumbar fusion.

STUDY DESIGN/SETTING

Retrospective cohort study.

PATIENT SAMPLE

Adults undergoing thoracolumbar fusion of =5 levels (single institution 2014-2024).

OUTCOME MEASURES

Ninety-day complications, readmissions, and reoperations.

METHODS

Patient demographics, comorbidities, perioperative data (EBL, transfusions, etc.), and postoperative data (90-day complications, readmissions, reoperations) were collected. Analyses were performed separately for staged and unstaged patients, with differences with LMWH assessed via chi-squared and Fisher’s exact tests (a=0.05).

RESULTS

Overall, 191 staged (131 [68.6%] female, 66.7±9.2 years) and 216 unstaged (146 [67.6%] female, 67.7±9.8 years) patients were included. LMWH was given in 133 (70%) of staged surgeries and 107 (50%) of unstaged surgeries. Among staged patients, rates of PE were 3.1% (95% CI 1.2, 7.8) with LMWH vs 9.1% (4.0, 19.6) without LMWH (p=0.132), and rates of DVT were 4.7% (2.2, 9.9) with LMWH vs 5.5% (1.9, 14.9) without LMWH (p>0.999). Patients receiving LMWH had higher BMI (29.1 [28.2, 30.1] vs 27.0 [25.7, 28.2], p=0.011). Among unstaged patients, rates of PE were 3.9% (1.5, 9.6) with LMWH vs 3.1% (1.1, 8.8) without LMWH (p=0.185) and rates of DVT were 2.9% (1.0, 8.2) with LMWH vs 4.2% (1.6, 10.2) without LMWH (p=0.338). In both staged and unstaged cohorts, transfusion rates (and amounts) were comparable with vs without LMWH (Staged: 96.4% [87.7, 99.0] vs 92.1% [86.1, 95.7], [p=0.352]; Unstaged: 73.8% [64.6, 81.3] vs 76.0% [66.6, 83.5], p=0.387). Complications, readmission, and 6-month reoperation were also comparable with vs without LMWH.

CONCLUSIONS

In the largest study to date directly comparing long thoracolumbar fusion with vs. without LMWH prophylaxis, LMWH did not increase bleeding or transfusions. LMWH may provide benefits, particularly in PE reduction; however, large population-based study is needed for confirmation.