Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; University of Tokyo Spine Group (UTSG), Tokyo, Japan.
University of Tokyo Spine Group (UTSG), Tokyo, Japan; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan.
World Neurosurg. 2022 Feb;158:e362-e368. doi: 10.1016/j.wneu.2021.10.182. Epub 2021 Nov 4.
To investigate the influence of perioperative antithrombotic agent (antiplatelet agents and anticoagulants) discontinuation in elective posterior spinal surgery in terms of bleeding complications, such as epidural hematoma and postoperative thromboembolism.
We enrolled patients undergoing elective posterior spinal surgery at 9 hospitals between April 2017 and August 2020. We collected data regarding patient baseline characteristics, surgical details, intraoperative estimated blood loss, and postoperative complication rates, including epidural hematoma and thromboembolism. We divided the patients into a discontinuation group, in which antithrombic agents were discontinued perioperatively, and a control group without antithrombic agents. Propensity scores for taking any antithrombic agents were calculated, with 1-to-1 matching based on the estimated propensity scores to adjust for patient baseline characteristics and surgical details. Intraoperative estimated blood loss and 30-day postoperative complication rates were compared between the groups.
We enrolled 9853 patients, including 1123 patients (11.4%) who discontinued antithrombic agents perioperatively. One-to-one propensity score matching yielded 1111 pairs with and without antithrombic agents. Intraoperative estimated blood loss per 10 minutes (8.2 mL vs. 8.9 mL) and the incidence of epidural hematoma requiring revision (0.97% vs. 0.72%) were similar between the groups. Although postoperative cardiac events and stroke were observed only in the discontinuation group (0.27% and 0.09%, respectively), these incidences were not significantly different between the groups.
Perioperative antithrombic agent discontinuation in elective posterior spinal surgery normalized the intraoperative bleeding tendency and the incidence of postoperative epidural hematoma and did not influence in a significative way the incidence of postoperative thromboembolism.
探讨择期后路脊柱手术中抗栓药物（抗血小板药物和抗凝剂）停药对出血并发症（如硬膜外血肿和术后血栓栓塞）的影响。
我们纳入了 2017 年 4 月至 2020 年 8 月在 9 家医院接受择期后路脊柱手术的患者。我们收集了患者的基线特征、手术细节、术中估计失血量和术后并发症发生率（包括硬膜外血肿和血栓栓塞）的数据。我们将患者分为停药组（术中停药）和对照组（未使用抗栓药物）。计算服用任何抗栓药物的倾向评分，并根据估计的倾向评分进行 1:1 匹配，以调整患者的基线特征和手术细节。比较两组患者的术中估计失血量和 30 天术后并发症发生率。
我们纳入了 9853 例患者，其中 1123 例（11.4%）患者在围手术期停用抗栓药物。1:1 倾向评分匹配得到了 1111 对有和无抗栓药物的患者。每 10 分钟的术中估计失血量（8.2 毫升比 8.9 毫升）和需要翻修的硬膜外血肿发生率（0.97%比 0.72%）在两组之间相似。尽管停药组仅观察到术后心脏事件和中风（0.27%和 0.09%），但两组之间的发生率没有显著差异。
择期后路脊柱手术中抗栓药物停药可使术中出血倾向和术后硬膜外血肿发生率正常化，并且不会显著影响术后血栓栓塞的发生率。
