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Operative Spinal Trauma: Thromboprophylaxis with Low-Molecular-Weight Heparin or a Direct Oral Anticoagulant.

Research paper by Mohammad M Hamidi, Muhammad M Zeeshan, Narong N Kulvatunyou, Hari S HS Mitra, Kamil K Hanna, Andrew A Tang, Ashley A Northcutt, Terence T O'Keeffe, Bellal B Joseph

Indexed on: 31 May '19Published on: 30 Mar '19Published in: Journal of Thrombosis and Haemostasis



Abstract

Spinal trauma patients are at high-risk for venous thromboembolism (VTE). Compare the impact of direct oral anticoagulants (DOACs) and low-molecular-weight heparin (LMWH) as thromboprophylactic agents on outcomes in operative spinal trauma patients. A 2-year (2015-16) retrospective cohort analysis of such patients (spinal-Abbreviated injury Score [AIS] ≥ 3 and other-AIS < 3) who received LMWH or DOACs. Propensity-score matching (1:2 ratio) followed stratification into two groups. Outcomes included rates of deep venous thrombosis (DVT) and/or pulmonary embolism (PE), packed red blood cells (pRBCs) transfusion, operative interventions for spinal cord decompression, and mortality. Of 6,036 patients, 810 (270 DOACs; 540 LMWH) were matched. The mean age was 62±15y, 58% were male, and the median Injury Severity Score was 12[10-18]. Matched groups were similar in demographics, injury parameters, emergency department vitals, hospital stay, rates of inferior vena cava filter placement, and timing of initiation of thromboprophylaxis. The overall rate of in-hospital DVT was 5.6%, PE was 1.6%, and mortality was 2.5%. DOACs patients were less likely to develop DVT (1.8% vs. 7.4%) and PE (0.3% vs. 2.1%). There was no difference in post-prophylaxis pRBCs transfusion requirements, post-prophylaxis decompressive procedure on the spinal cord, or mortality. In operative spinal trauma patients, thromboprophylaxis with DOACs appears to be associated with lower rates of DVT and PE. Further prospective clinical trials should evaluate the role of DOACs in preventing VTE events in spinal trauma. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

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