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Perioperative Anticoagulation Management in Spine Surgery: Initial Findings From the AO Spine Anticoagulation Global Survey.

TitlePerioperative Anticoagulation Management in Spine Surgery: Initial Findings From the AO Spine Anticoagulation Global Survey.
Publication TypeJournal Article
Year of Publication2020
AuthorsLouie P, Harada G, Harrop J, Mroz T, Al-Saleh K, Brodano GBarbanti, Chapman J, Fehlings M, Hu S, Kawaguchi Y, Mayer M, Menon V, Park J-B, Qureshi S, Rajasekaran S, Valacco M, Vialle L, Wang JC, Wiechert K, K Riew D, Samartzis D
JournalGlobal Spine J
Volume10
Issue5
Pagination512-527
Date Published2020 Aug
ISSN2192-5682
Abstract

STUDY DESIGN: Cross-sectional, international survey.

OBJECTIVES: This study addressed the global perspectives concerning perioperative use of pharmacologic thromboprophylaxis during spine surgery along with its risks and benefits.

METHODS: A questionnaire was designed and implemented by expert members in the AO Spine community. The survey was distributed to AO Spine's spine surgeon members (N = 3805). Data included surgeon demographic information, type and region of practice, anticoagulation principles, different patient scenarios, and comorbidities.

RESULTS: A total of 316 (8.3% response rate) spine surgeons completed the survey, representing 64 different countries. Completed surveys were primarily from Europe (31.7%), South/Latin America (19.9%), and Asia (18.4%). Surgeons tended to be 35 to 44 years old (42.1%), fellowship-trained (74.7%), and orthopedic surgeons (65.5%) from academic institutions (39.6%). Most surgeons (70.3%) used routine anticoagulation risk stratification, irrespective of geographic location. However, significant differences were seen between continents with anticoagulation initiation and cessation methodology. Specifically, the length of a procedure ( = .036) and patient body mass index ( = .008) were perceived differently when deciding to begin anticoagulation, while the importance of medical clearance ( < .001) and reference to literature ( = .035) differed during cessation. For specific techniques, most providers noted use of mobilization, low-molecular-weight heparin, and mechanical prophylaxis beginning on postoperative 0 to 1 days. Conversely, bridging regimens were bimodal in distribution, with providers electing anticoagulant initiation on postoperative 0 to 1 days or days 5-6.

CONCLUSION: This survey highlights the heterogeneity of spine care and accentuates geographical variations. Furthermore, it identifies the difficulty in providing consistent perioperative anticoagulation recommendations to patients, as there remains no widely accepted, definitive literature of evidence or guidelines.

DOI10.1177/2192568219897598
Alternate JournalGlobal Spine J
PubMed ID32677576
PubMed Central IDPMC7359688