Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
World Neurosurg. 2021 Jun;150:e144-e154. doi: 10.1016/j.wneu.2021.02.120. Epub 2021 Mar 6.
Venous thromboembolism (VTE) is a significant contributor to postoperative morbidity and mortality. Prophylactic regimens for VTE involve mechanical prophylaxis and pharmacoprophylaxis. This systematic review and meta-analysis aimed to determine the efficacy and safety of pharmacoprophylaxis in comparison with any nonpharmacoprophylaxis regimen for the prevention of postoperative VTE in patients undergoing spinal surgery.
MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and ICRCTN were searched for comparative studies including both pharmacoprophylaxis and nonpharmacoprophylaxis post spinal surgery. The primary outcome was the incidence of VTE within the postoperative hospitalized period. Secondary outcomes included the incidence of spinal epidural hematoma, significant bleeding events, and other adverse events associated with VTE. The data was pooled using random-effects models of meta-analysis and relative risk (RR) was calculated.
Four retrospective and 3 randomized controlled trials representing a total of 8373 patients were included. Overall, there was a significant decrease in postoperative deep venous thrombosis with pharmacoprophylaxis versus nonpharmacoprophylaxis (RR 0.42, 95% confidence interval 0.21-0.86, P = 0.02, I = 0%); however, there were no significant differences between the groups in the incidences of VTE (RR 0.31, 95% confidence interval 0.12-0.81, P = 0.02, I = 0%). The incidences of spinal epidural hematoma and significant bleeding events were rare and comparable in both groups.
This systematic review and meta-analysis found a potential benefit with pharmacoprophylaxis post spinal surgery in the prevention of deep venous thrombosis. However, there is a need for future randomized controlled trials to investigate the efficacy and safety of pharmacoprophylaxis in spinal surgery across various spinal procedures.
静脉血栓栓塞症（VTE）是术后发病率和死亡率的重要原因。VTE 的预防方案包括机械预防和药物预防。本系统评价和荟萃分析旨在确定药物预防与任何非药物预防方案在预防脊柱手术后患者术后 VTE 方面的疗效和安全性。
检索 MEDLINE、Embase、Cochrane 对照试验中心注册库、ClinicalTrials.gov 和 ICRCTN，以纳入包括脊柱手术后药物预防和非药物预防的比较研究。主要结局是术后住院期间 VTE 的发生率。次要结局包括硬膜外血肿、明显出血事件和与 VTE 相关的其他不良事件的发生率。使用荟萃分析的随机效应模型和相对风险（RR）计算数据汇总。
纳入了 4 项回顾性研究和 3 项随机对照试验，共 8373 例患者。总体而言，与非药物预防相比，药物预防可显著降低术后深静脉血栓形成的发生率（RR 0.42，95%置信区间 0.21-0.86，P = 0.02，I = 0%）；然而，两组 VTE 发生率无显著差异（RR 0.31，95%置信区间 0.12-0.81，P = 0.02，I = 0%）。硬膜外血肿和明显出血事件的发生率较低，且两组相似。
本系统评价和荟萃分析发现，脊柱手术后药物预防在预防深静脉血栓形成方面可能有益。然而，需要未来的随机对照试验来研究药物预防在各种脊柱手术中的疗效和安全性。
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