Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery
Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery
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DOI：
10.1007/s00586-003-0642-8
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发表时间：
2004-02-01
影响因子：
2.8
通讯作者：
Seifert, V
中科院分区：
文献类型：
--
作者：
Gerlach, R;Raabe, A;Seifert, V
目的：在接受脊柱手术的大型患者队列中，确定那屈肝素（速碧林）+加压袜术后早期给药3年期间的术后出血风险。研究方法：本研究纳入了1999年6月至2002年在法兰克福约翰-沃尔夫冈-歌德大学神经外科进行的总计1，954例不同节段的脊柱手术（503例颈椎，152例胸椎和1，299例腰椎）。为了预防静脉血栓栓塞事件（VTE），所有患者均在术后早期（24小时内）常规皮下注射0.3 ml那屈肝素钙（速碧林）（2850 IU抗Xa，Sanofi温斯洛普工业公司，法国），并在出院前使用术中和术后加压袜。在数据库中记录术后血肿（定义为由于空间占用和/或神经功能恶化而需要手术清除的血肿）和深静脉血栓形成（DVT）的发生率，并进行回顾性分析。结果：1,954例脊柱手术中有13例（0.7%）发生了严重的术后并发症。13例患者中的5例（38.5%）出血发生在手术当天那屈肝素给药前。因此，接受那屈肝素治疗的患者的出血率为0.4%（8/1，949）。13例发生严重术后血肿的患者中有10例（77%）表现出进行性神经功能缺损，其中6例患者消退，导致血肿相关发病率为31%（4/13）。该系列中只有1例患者（0.05%）发生了临床上明显的DVT，并且在住院期间没有患者发生肺栓塞。结论：虽然是回顾性的，但这是迄今为止提供脊柱手术后早期术后抗凝相关出血率信息的最大研究。结果证实，在脊柱手术患者中使用那屈肝素进行早期术后药物血栓栓塞预防与术后出血风险增加无关。
Aim: To determine the risk of postoperative hemorrhage during a 3-year period of early postoperative administration of nadroparin (Fraxiparin) plus compression stockings in a large cohort of patients who underwent spinal surgery. Methods: A total of 1,954 spinal procedures at different levels (503 cervical, 152 thoracic and 1,299 lumbar), performed between June 1999 and 2002 at the Department of Neurosurgery, Johann-Wolfgang-Goethe University Frankfurt, were included in this study. To prevent venous thromboembolic events (VTE), all patients were routinely treated subcutaneously with 0.3 ml of early (less than 24 h) postoperative nadroparin calcium (Fraxiparin) (2850 IU anti-Xa, Sanofi Winthrop Industrie, France) plus intra- and postoperative compression stockings until discharge. The occurrence of a postoperative hematoma (defined as a hematoma requiring surgical evacuation because of space occupation and/or neurological deterioration) and a deep venous thrombosis (DVT) were recorded in a database and analyzed retrospectively. Results: 13 (0.7%) of the 1,954 spinal operations were complicated by major postoperative hemorrhages. In 5 of the 13 patients (38.5%) the hemorrhage occurred on the day of surgery before the administration of nadroparin. Thus, the hemorrhage rate of patients receiving nadroparin was 0.4% (8/1,949). Ten (77%) of the 13 patients with major postoperative hematoma showed a progressive neurological deficit, which resolved in 6 patients and resulted in a hematoma-related morbidity of 31% (4/13). Only 1 patient (0.05%) in this series developed a clinically evident DVT, and none of the patients suffered from pulmonary embolus during the hospital stay. Conclusion: Although retrospective, this is to date the largest study providing information about the hemorrhage rate associated with early postoperative anticoagulation following spinal surgery. The results confirm that early postoperative pharmacological thromboembolic prophylaxis using nadroparin in patients with spinal surgery is not associated with an increased risk of postoperative hemorrhage.