Department of Neurosurgery, Neuroendoscope center, Ijinkai Takeda General Hospital, 28-1 Ishidamoriminamichou, Fushimi, Kyoto, 601-1495, Japan.
Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Osaka, Japan.
Acta Neurochir (Wien). 2024 Jun 12;166(1):262. doi: 10.1007/s00701-024-06156-1.
Each institution or physician has to decide on an individual basis whether to continue or discontinue antiplatelet (AP) therapy before spinal surgery. The purpose of this study was to determine if perioperative AP continuation is safe during single-level microsurgical decompression (MSD) for treating lumbar spinal stenosis (LSS) and lumbar disc hernia (LDH) without selection bias.
Patients who underwent single-level MSD for LSS and LDH between April 2018 to December 2022 at our institute were included in this retrospective study. We collected data regarding baseline characteristics, medical history/comorbidities, epidural hematoma (EDH) volume, reoperation for EDH, differences between preoperative and one-day postoperative blood cell counts (ΔRBC), hemoglobin (ΔHGB), and hematocrits (ΔHCT), and perioperative thromboembolic complications. Patients were divided into two groups: the AP continuation group received AP treatment before surgery and the control group did not receive antiplatelet medication before surgery. Propensity scores for receiving AP agents were calculated, with one-to-one matching of estimated propensity scores to adjust for patient baseline characteristics and past histories. Reoperation for EDH, EDH volume, ΔRBC, ΔHGB, ΔHCT, and perioperative thromboembolic complications were compared between the groups.
The 303 enrolled patients included 41 patients in the AP continuation group. After propensity score matching, the rate of reoperation for EDH, the EDH volume, ΔRBC, ΔHGB, ΔHCT, and perioperative thromboembolic complication rates were not significantly different between the groups.
Perioperative AP continuation is safe for single-level lumbar MSD, even without biases.
在进行脊柱手术前，每个机构或医生都必须根据个人情况决定是否继续或停止抗血小板（AP）治疗。本研究的目的是确定在没有选择偏倚的情况下，在单节段显微减压（MSD）治疗腰椎管狭窄症（LSS）和腰椎间盘突出症（LDH）期间，围手术期继续使用 AP 是否安全。
本回顾性研究纳入了 2018 年 4 月至 2022 年 12 月期间在我院接受单节段 MSD 治疗的 LSS 和 LDH 患者。我们收集了基线特征、病史/合并症、硬膜外血肿（EDH）体积、EDH 再手术、术前和术后一天血细胞计数（ΔRBC）、血红蛋白（ΔHGB）和红细胞压积（ΔHCT）差异以及围手术期血栓栓塞并发症的数据。患者分为两组：AP 继续组在术前接受 AP 治疗，对照组在术前未接受抗血小板药物治疗。计算接受 AP 药物的倾向评分，并进行一对一的倾向评分匹配，以调整患者的基线特征和既往病史。比较两组之间 EDH 再手术、EDH 体积、ΔRBC、ΔHGB、ΔHCT 和围手术期血栓栓塞并发症的发生率。
303 名入组患者中，AP 继续组有 41 名患者。在倾向评分匹配后，两组之间 EDH 再手术率、EDH 体积、ΔRBC、ΔHGB、ΔHCT 和围手术期血栓栓塞并发症发生率均无显著差异。
即使没有偏倚，围手术期继续使用 AP 对单节段腰椎 MSD 是安全的。
