Uehara Masashi, Ikegami Shota, Takizawa Takashi, Oba Hiroki, Yokogawa Noriaki, Sasagawa Takeshi, Ando Kei, Nakashima Hiroaki, Segi Naoki, Funayama Toru, Eto Fumihiko, Yamaji Akihiro, Watanabe Kota, Nori Satoshi, Takeda Kazuki, Furuya Takeo, Orita Sumihisa, Nakajima Hideaki, Yamada Tomohiro, Hasegawa Tomohiko, Terashima Yoshinori, Hirota Ryosuke, Suzuki Hidenori, Imajo Yasuaki, Tonomura Hitoshi, Sakata Munehiro, Hashimoto Ko, Onoda Yoshito, Kawaguchi Kenichi, Haruta Yohei, Suzuki Nobuyuki, Kato Kenji, Uei Hiroshi, Sawada Hirokatsu, Nakanishi Kazuo, Misaki Kosuke, Terai Hidetomi, Tamai Koji, Shirasawa Eiki, Inoue Gen, Kakutani Kenichiro, Kakiuchi Yuji, Kiyasu Katsuhito, Tominaga Hiroyuki, Tokumoto Hiroto, Iizuka Yoichi, Takasawa Eiji, Akeda Koji, Takegami Norihiko, Funao Haruki, Oshima Yasushi, Kaito Takashi, Sakai Daisuke, Yoshii Toshitaka, Ohba Tetsuro, Otsuki Bungo, Seki Shoji, Miyazaki Masashi, Ishihara Masayuki, Okada Seiji, Aoki Yasuchika, Harimaya Katsumi, Murakami Hideki, Ishii Ken, Ohtori Seiji, Imagama Shiro, Kato Satoshi
Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa, Japan.
Spine Surg Relat Res. 2021 Dec 27;6(4):366-372. doi: 10.22603/ssrr.2021-0183. eCollection 2022.
In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly. The present multicenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma.
The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well.
Of the 776 patients (mean age: 75.1±6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases.
This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly.
在老年颈脊髓损伤患者中，心血管和脑血管疾病等合并症很常见，且常使用抗血小板/抗凝（APAC）药物。尽管术前停用了APAC药物，但这类患者在手术期间仍可能容易出血或意外出血。关于老年颈椎损伤手术，很少有报告研究术中失血与APAC用药史之间的确切关系。本多中心数据库调查旨在回答使用APAC药物是否会影响老年颈脊髓损伤患者术中失血量这一问题。
回顾性分析了33家机构的1512例颈椎损伤患者的病历。排除未进行脊柱手术或已知失血量的病例后，纳入797例患者。失血量是感兴趣的结果。我们使用治疗权重的逆概率（IPTW）方法计算倾向得分。作为另一种敏感性分析，还进行了线性混合模型分析。
在776例符合IPTW计算条件的患者（平均年龄：75.1±6.4岁）中，157例（20.2%）在受伤前服用APAC药物。加权后，非APAC患者的平均估计失血量为204 mL，APAC患者为215 mL。根据倾向评分的IPTW方法或线性混合模型分析，老年患者使用APAC与手术失血无显著关联。因此，在APAC和非APAC病例中，似乎可以预期手术失血量相当。
这项多中心研究表明，服用APAC药物的老年颈椎创伤患者手术失血量没有显著增加。在检查老年颈椎创伤的手术指征时，外科医生在考虑受伤前的APAC使用情况之前，可能能够优先考虑患者背景、并发症和既往疾病。
