一项择期脊柱手术中静脉血栓栓塞预防方案：单中心经验的回顾性评估
A Protocol for Venous Thromboembolism Prophylaxis in Elective Spine Surgery: A Retrospective Evaluation of a Single-Center Experience.
作者信息
Aljohani Hani, Alashkar Abdulrahman H, Alkafarnah Ghada K, Almeshigeh Monirh M, Alsadoon Abdullh A, Alfakhouri Amr
机构信息
College of Medicine, Qassim University, Buraidah, SAU.
Department of Surgery, Dr. Sulaiman Al-Habib Medical Group, Buraidah, SAU.
出版信息
Cureus. 2025 Jun 3;17(6):e85297. doi: 10.7759/cureus.85297. eCollection 2025 Jun.
INTRODUCTION
Venous thromboembolic (VTE) events include deep vein thrombosis (DVT) and pulmonary embolism (PE). In spine surgery, the risk of VTE events should be weighed against the risk of developing epidural hematoma (EDH). This has made the subject of VTE prophylaxis in spine surgery an ongoing matter of debate in the scientific community.
OBJECTIVE
To present our experience with venous thromboembolism prophylaxis in patients undergoing elective spine surgery and discuss it in the light of the literature.
METHODS
This was a retrospective review done on all patients who underwent elective spine surgery at our institution from 2019 to 2024 and were prescribed a specified VTE prophylaxis protocol (inpatient enoxaparin and a seven-day course of rivaroxaban following discharge). Patients who underwent spine surgery for non-elective indications, were known to have a malignancy, had a history of VTE, were already on anticoagulant therapy, and/or were non-ambulatory, were excluded.
RESULTS
A total of 528 patients were included; 284 (53.78%) patients were males, and 354 (67.04%) surgeries were thoraco-lumbar. Of the 174 (32.95%) surgeries performed on the cervical spine, 105 were anterior discectomies and 69 were laminectomies. The mean age (±SD) was 55.06 years (±14.9). The majority of the included patients were overweight/obese; 447 patients (84.65%). Of all the patients, 452 (85.6%) started to ambulate on Day 1, and the mean (±SD) length of hospital stay was comparable for patients undergoing cervical and thoracolumbar spine surgeries, 4.6 (±1.3) and 4.8 (±1.6), respectively. None of the patients experienced VTE events, while three (0.56%) developed EDH.
CONCLUSION
The protocol presented in this report is safe and effective in preventing VTE in ambulatory patients undergoing elective spine surgery. Rivaroxaban is a possible option for VTE prophylaxis in patients undergoing elective spine surgery, including procedures involving the cervical spine.
引言
静脉血栓栓塞（VTE）事件包括深静脉血栓形成（DVT）和肺栓塞（PE）。在脊柱手术中，VTE事件的风险应与硬膜外血肿（EDH）形成的风险相权衡。这使得脊柱手术中VTE预防这一主题一直是科学界争论的焦点。
目的
介绍我们在接受择期脊柱手术患者中进行静脉血栓栓塞预防的经验，并结合文献进行讨论。
方法
这是一项对2019年至2024年在我们机构接受择期脊柱手术且被规定采用特定VTE预防方案（住院期间使用依诺肝素，出院后服用七天的利伐沙班）的所有患者进行的回顾性研究。排除因非择期指征接受脊柱手术、已知患有恶性肿瘤、有VTE病史、已在接受抗凝治疗和/或不能行走的患者。
结果
共纳入528例患者；284例（53.78%）为男性，354例（67.04%）手术为胸腰椎手术。在174例（32.95%）颈椎手术中，105例为前路椎间盘切除术，69例为椎板切除术。平均年龄（±标准差）为55.06岁（±14.9）。纳入的患者大多数超重/肥胖；447例患者（84.65%）。所有患者中，452例（85.6%）在第1天开始行走，颈椎和胸腰椎脊柱手术患者的平均（±标准差）住院时间相当，分别为4.6（±1.3）天和4.8（±1.6）天。没有患者发生VTE事件，而3例（0.56%）发生了EDH。
结论
本报告中提出的方案在预防接受择期脊柱手术的可行走患者发生VTE方面是安全有效的。利伐沙班是接受择期脊柱手术患者（包括涉及颈椎的手术）VTE预防的一种可能选择。
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