Nimmons Scott, Rizkalla James, Solis Jaicus, Dawkins Jonathan, Syed Ishaq
22683Baylor University Medical Center, Dallas, TX, USA.
Global Spine J. 2022 Sep;12(7):1321-1329. doi: 10.1177/2192568220979139. Epub 2021 Apr 20.
Systematic literature review.
The impact of thromboembolic disease on the morbidity and mortality of patients with acute spinal cord injury is well documented, with rates as high as 67%-100% among untreated patients. The efficacy of mechanical prophylaxis as a stand-alone measure has been questioned, so we sought to determine a safe perioperative window for chemical anticoagulation use after spine surgery. Many surgeons have concerns anticoagulants may cause post-operative hematoma.
A systematic literature review was performed, ultimately yielding 13 articles. Based on the existing literature and input from our multidisciplinary institutional trauma committee, a Spine Trauma DVT Prophylaxis Protocol was developed.
Effort was placed to identify cases within our institution in which patients suffered vertebral column fractures and/or spinal cord injuries. Of these 466 vertebral column fractures and/or spinal cord injuries, 4 patients were identified and diagnosed with DVTs while admitted.
Of these patients, there is a clear dilemma with regard to safety of chemoprophylaxis use versus risk of developing a DVT. Though none of the patients developed a PE, utilizing the protocol would have led to earlier IVC filter placement or initiation of a VTE surveillance protocol in 2 of the patients. Initiation of enoxaparin before surgery in one patient (despite delay of surgical timing) may have avoided his subsequent LUE DVT. Though not appropriate for all clinical scenarios, we are confident that our treatment algorithm will prove beneficial for patient care in avoiding DVTs and helping trauma surgeons with evidence-based clinical decision making.
系统文献综述。
血栓栓塞性疾病对急性脊髓损伤患者发病率和死亡率的影响已有充分记录，在未经治疗的患者中发生率高达67%-100%。机械预防作为单一措施的有效性受到质疑，因此我们试图确定脊柱手术后使用化学抗凝的安全围手术期窗口。许多外科医生担心抗凝剂可能导致术后血肿。
进行了系统文献综述，最终得到13篇文章。基于现有文献和我们多学科机构创伤委员会的意见，制定了脊柱创伤深静脉血栓预防方案。
我们努力在本机构内识别脊柱骨折和/或脊髓损伤的病例。在这466例脊柱骨折和/或脊髓损伤患者中，有4例在住院期间被确诊为深静脉血栓形成。
在这些患者中，化学预防使用的安全性与发生深静脉血栓的风险之间存在明显的两难困境。尽管没有患者发生肺栓塞，但采用该方案可能会使2例患者更早地放置下腔静脉滤器或启动静脉血栓栓塞监测方案。在1例患者中，术前开始使用依诺肝素（尽管手术时间延迟）可能避免了其随后发生的左上肢深静脉血栓形成。虽然不适用于所有临床情况，但我们相信我们的治疗算法将证明对患者护理有益，可避免深静脉血栓形成，并帮助创伤外科医生进行基于证据的临床决策。
