Influence of Perioperative Antithrombic Agent Discontinuation in Elective Posterior Spinal Surgery: A Propensity-Score-Matched Analysis
Influence of Perioperative Antithrombic Agent Discontinuation in Elective Posterior Spinal Surgery: A Propensity-Score-Matched Analysis
复制标题
围手术期抗血栓药物停用对择期脊柱后路手术的影响：倾向评分匹配分析
DOI：
10.1016/j.wneu.2021.10.182
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发表时间：
2022
影响因子：
2
通讯作者：
Oshima Yasushi
中科院分区：
文献类型：
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作者：
Okamoto Naoki;Kato So;Doi Toru;Nakamoto Hideki;Matsubayashi Yoshitaka;Taniguchi Yuki;Inanami Hirohiko;Higashikawa Akiro;Kawamura Naohiro;Hara Nobuhiro;Azuma Seiichi;Takeshita Yujiro;Ono Takashi;Fukushima Masayoshi;Tanaka Sakae;Oshima Yasushi
目的探讨择期脊柱后路手术围手术期停用抗血栓药物（抗血小板药物和抗凝剂）对出血并发症（如硬膜外血肿和术后血栓栓塞）的影响。方法我们招募了2017年4月至2020年8月在9家医院接受择期脊柱后路手术的患者。我们收集了有关患者基线特征、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和对照组，停药组在围手术期停用抗血栓药物，对照组不使用抗血栓药物。计算服用任何抗血栓药物的倾向评分，根据估计的倾向评分进行1对1匹配，以调整患者基线特征和手术细节。术中估计失血量和30天的术后并发症发生率进行了比较groups.ResultsWe入组9853例，其中包括1123例（11.4%）围手术期停用抗血栓药物。一对一的倾向评分匹配产生了1111对有和没有抗血栓药物。两组的术中估计每10分钟失血量（8.2 mL vs. 8.9 mL）和需要翻修的硬膜外血肿发生率（0.97% vs. 0.72%）相似。虽然仅在停药组中观察到术后心脏事件和卒中（分别为0.27%和0.09%），结论：择期后路脊柱手术围手术期停用抗血栓药物可使术中出血倾向和术后硬膜外血肿的发生率正常化，但对术后硬膜外血肿的发生率无显著影响。术后血栓栓塞
ObjectiveTo 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.MethodsWe 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.ResultsWe 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.ConclusionsPerioperative 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.