Porto Guilherme B F, Jeffrey Wessell D O, Alvarado Anthony, Arnold Paul M, Buchholz Avery L
Medical University of South Carolina, Charleston, SC, USA.
University of Kansas, Kansas City, KS, USA.
Global Spine J. 2020 Jan;10(1 Suppl):53S-64S. doi: 10.1177/2192568219852051. Epub 2020 Jan 6.
Literature review.
Preoperative management of therapeutic anticoagulation in spine surgery is critical to minimize risk of thromboembolic events yet prevent postsurgical complications. Limited research is available, and most guidelines are based on drug half-lives. We aim to clarify current guidelines and available evidence for safe practice of spine surgery in this patient population.
A literature search in PubMed was done encompassing comprehensive search terms to locate published literature on anticoagulation and spine surgery. Predefined inclusion and exclusion criteria were applied and data extraction was performed.
A total of 17 articles met the final inclusion criteria. Of these, 12 articles were retrospective chart reviews, 3 were prospective observational studies, and 2 were systematic reviews. Current practice suggests holding warfarin until international normalized ratio <1.4, anti-Xa drugs for 48 to 72 hours, 12 to 24 hours for low-molecular-weight heparin, and 4 to 24 hours for heparin, before surgery. Antiplatelet agents can be stopped for 1 to 3 days prior to operation (81-500 mg) but must be stopped for 1 week for doses >1 g/d. For Plavix, 5 to 7 days of discontinuation advised to prevent complications.
This review provides an overview of main anticoagulation agents seen in preoperative setting for spine patients. Although data is mixed and no true randomized control trials are available, there is growing evidence suggesting the aforementioned guidelines are needed to optimize anticoagulation in setting of spine surgery. Further studies are needed to elucidate risk of complications while operating under therapeutic levels of anticoagulation for a variety of comorbid conditions.
文献综述。
脊柱手术中治疗性抗凝的术前管理对于将血栓栓塞事件的风险降至最低同时预防术后并发症至关重要。现有研究有限，且大多数指南基于药物半衰期。我们旨在阐明针对该患者群体进行脊柱手术安全操作的当前指南和现有证据。
在PubMed中进行文献检索，使用全面的检索词来查找关于抗凝与脊柱手术的已发表文献。应用预定义的纳入和排除标准并进行数据提取。
共有17篇文章符合最终纳入标准。其中，12篇文章为回顾性病历审查，3篇为前瞻性观察性研究，2篇为系统评价。目前的做法建议在手术前停用华法林直至国际标准化比值<1.4，停用抗Xa药物48至72小时，停用低分子量肝素12至24小时，停用肝素4至24小时。抗血小板药物可在手术前1至3天停用（81 - 500毫克），但剂量>1克/天时必须停用1周。对于波立维，建议停用5至7天以预防并发症。
本综述概述了脊柱患者术前使用的主要抗凝药物。尽管数据不一且尚无真正的随机对照试验，但越来越多的证据表明需要上述指南来优化脊柱手术中的抗凝。需要进一步研究以阐明在各种合并症的治疗性抗凝水平下手术时并发症的风险。
