Jablawi Fidaa, Schubert Gerrit Alexander, Hans Franz-Josef, Mull Michael
Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University Hospital, Aachen, Germany; Department of Neurosurgery, Justus-Liebig-University, Giessen, Germany.
Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany.
World Neurosurg. 2018 Jun;114:e698-e705. doi: 10.1016/j.wneu.2018.03.061. Epub 2018 Mar 14.
Effectiveness and safety of anticoagulation therapy (AC) after treatment of spinal dural arteriovenous fistula (sdAVF) are still inadequately discussed in the literature and are addressed in this study.
We retrospectively analyzed our medical database for patients with sdAVF treated in our institution between 2006 and 2016. Neurologic status at time of admission, discharge, and last follow-up was assessed via Aminoff-Logue disability score. Patient cohorts were dichotomized as group A (postoperative therapeutic heparinization) and group B (routine thromboembolic prophylaxis with low-dose heparin).
Fifty-three patients were included in this analysis. In group A (n = 11), no acute deterioration was reported. In group B (n = 42), 4 patients developed acute postoperative deterioration; therapeutic AC was initiated in all 4 patients resulting in complete neurologic recovery within the inpatient stay. However, the incidence of postoperative deterioration did not reach statistical significance between treatment groups (P = 0.57). Data of 40 patients were available for long-term analysis (mean, 53.4 ± 36 months). Neurologic status did not differ significantly between both groups at time of admission (P = 0.093), discharge (P = 0.723), and last follow-up (P = 0.222).
Acute postoperative deterioration in patients with sdAVF is a clinically relevant complication and was present in 7.5% of patients in our series. Although routine therapeutic AC did not decrease the rate of acute deterioration significantly, our findings imply that therapeutic AC in cases of acute postoperative deterioration might be a safe and efficient treatment option.
脊髓硬脊膜动静脉瘘（sdAVF）治疗后抗凝治疗（AC）的有效性和安全性在文献中仍讨论不足，本研究对此进行探讨。
我们回顾性分析了2006年至2016年在我院接受治疗的sdAVF患者的医疗数据库。通过阿明诺夫-洛格残疾评分评估入院时、出院时及末次随访时的神经功能状态。将患者队列分为A组（术后治疗性肝素化）和B组（低剂量肝素常规血栓栓塞预防）。
本分析纳入53例患者。A组（n = 11）未报告急性病情恶化。B组（n = 42）中有4例患者术后出现急性病情恶化；所有4例患者均开始进行治疗性抗凝，住院期间神经功能完全恢复。然而，治疗组之间术后恶化的发生率未达到统计学显著性差异（P = 0.57）。40例患者的数据可用于长期分析（平均53.4±36个月）。两组在入院时（P = 0.093）、出院时（P = 0.723）及末次随访时（P = 0.222）的神经功能状态无显著差异。
sdAVF患者术后急性病情恶化是一种临床相关并发症，在我们的系列研究中占患者的7.5%。虽然常规治疗性抗凝并未显著降低急性恶化率，但我们的研究结果表明，术后急性恶化时进行治疗性抗凝可能是一种安全有效的治疗选择。
