Operative spinal trauma: Thromboprophylaxis with low molecular weight heparin or a direct oral anticoagulant

Mohammad Hamidi, Muhammad Zeeshan, Narong Kulvatunyou, Hari S. Mitra, Kamil Hanna, Andrew - Tang, Ashley Northcutt, Terence S Okeeffe, Bellal A Joseph

Research output: Contribution to journalArticle

Abstract

Essentials Operative spine trauma patients are at increased risk of venous thromboembolism (VTE). Direct oral anticoagulants (DOACs) may have a favorable efficacy and safety in spine trauma. Patients on DOACs had lower rates of VTE in comparison to low molecular weight heparin. DOACs did not augment the risk of surgical bleeding (transfusion, decompressive procedures). Background: Spinal trauma patients are at high risk for venous thromboembolism (VTE). Objective: To compare the impacts of direct oral anticoagulants (DOACs) and low molecular weight heparin (LMWH) as thromboprophylactic agents on outcomes in operative spinal trauma patients. Methods: A 2-year (2015-2016) retrospective cohort analysis of such patients (spine Abbreviated Injury Scale [AIS] ≥ 3 and other AIS < 3) who received LMWH or DOACs was performed. Propensity score matching (1:2 ratio) followed stratification into two groups. Outcomes included rates of deep vein thrombosis (DVT) and/or pulmonary embolism (PE), packed red blood cell (pRBC) transfusion, operative interventions for spinal cord decompression, and mortality. Results: Of 6036 patients, 810 (270 receiving DOACs; 540 receiving LMWH) were matched. The mean age was 62 ± 15 years, 58% were male, and the median Injury Severity Score was 12 (10-18). Matched groups were similar in demographics, injury parameters, emergency department vital signs, 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%, the overall rate of in-hospital PE was 1.6%, and the mortality rate was 2.5%. DOAC patients were less likely to develop DVT (1.8% vs 7.4%) and PE (0.3% vs 2.1%). There were no differences in postprophylaxis pRBC transfusion requirements, postprophylaxis decompressive procedures on the spinal cord, or mortality. Conclusion: 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 patients.

Original languageEnglish (US)
JournalJournal of Thrombosis and Haemostasis
DOIs
StatePublished - Jan 1 2019

Fingerprint

Low Molecular Weight Heparin
Anticoagulants
Wounds and Injuries
Venous Thromboembolism
Pulmonary Embolism
Venous Thrombosis
Abbreviated Injury Scale
Erythrocyte Transfusion
Spine
Mortality
Spinal Cord
Vena Cava Filters
Propensity Score
Injury Severity Score
Vital Signs
Decompression
varespladib methyl
Hospital Emergency Service
Length of Stay
Cohort Studies

Keywords

  • direct oral anticoagulants
  • low molecular weight heparin
  • spinal trauma
  • thromboprophylaxis
  • venous thromboembolism

ASJC Scopus subject areas

  • Hematology

Cite this

Operative spinal trauma : Thromboprophylaxis with low molecular weight heparin or a direct oral anticoagulant. / Hamidi, Mohammad; Zeeshan, Muhammad; Kulvatunyou, Narong; Mitra, Hari S.; Hanna, Kamil; Tang, Andrew -; Northcutt, Ashley; Okeeffe, Terence S; Joseph, Bellal A.

In: Journal of Thrombosis and Haemostasis, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Operative spinal trauma: Thromboprophylaxis with low molecular weight heparin or a direct oral anticoagulant",
abstract = "Essentials Operative spine trauma patients are at increased risk of venous thromboembolism (VTE). Direct oral anticoagulants (DOACs) may have a favorable efficacy and safety in spine trauma. Patients on DOACs had lower rates of VTE in comparison to low molecular weight heparin. DOACs did not augment the risk of surgical bleeding (transfusion, decompressive procedures). Background: Spinal trauma patients are at high risk for venous thromboembolism (VTE). Objective: To compare the impacts of direct oral anticoagulants (DOACs) and low molecular weight heparin (LMWH) as thromboprophylactic agents on outcomes in operative spinal trauma patients. Methods: A 2-year (2015-2016) retrospective cohort analysis of such patients (spine Abbreviated Injury Scale [AIS] ≥ 3 and other AIS < 3) who received LMWH or DOACs was performed. Propensity score matching (1:2 ratio) followed stratification into two groups. Outcomes included rates of deep vein thrombosis (DVT) and/or pulmonary embolism (PE), packed red blood cell (pRBC) transfusion, operative interventions for spinal cord decompression, and mortality. Results: Of 6036 patients, 810 (270 receiving DOACs; 540 receiving LMWH) were matched. The mean age was 62 ± 15 years, 58{\%} were male, and the median Injury Severity Score was 12 (10-18). Matched groups were similar in demographics, injury parameters, emergency department vital signs, 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{\%}, the overall rate of in-hospital PE was 1.6{\%}, and the mortality rate was 2.5{\%}. DOAC patients were less likely to develop DVT (1.8{\%} vs 7.4{\%}) and PE (0.3{\%} vs 2.1{\%}). There were no differences in postprophylaxis pRBC transfusion requirements, postprophylaxis decompressive procedures on the spinal cord, or mortality. Conclusion: 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 patients.",
keywords = "direct oral anticoagulants, low molecular weight heparin, spinal trauma, thromboprophylaxis, venous thromboembolism",
author = "Mohammad Hamidi and Muhammad Zeeshan and Narong Kulvatunyou and Mitra, {Hari S.} and Kamil Hanna and Tang, {Andrew -} and Ashley Northcutt and Okeeffe, {Terence S} and Joseph, {Bellal A}",
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T2 - Thromboprophylaxis with low molecular weight heparin or a direct oral anticoagulant

AU - Hamidi, Mohammad

AU - Zeeshan, Muhammad

AU - Kulvatunyou, Narong

AU - Mitra, Hari S.

AU - Hanna, Kamil

AU - Tang, Andrew -

AU - Northcutt, Ashley

AU - Okeeffe, Terence S

AU - Joseph, Bellal A

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Essentials Operative spine trauma patients are at increased risk of venous thromboembolism (VTE). Direct oral anticoagulants (DOACs) may have a favorable efficacy and safety in spine trauma. Patients on DOACs had lower rates of VTE in comparison to low molecular weight heparin. DOACs did not augment the risk of surgical bleeding (transfusion, decompressive procedures). Background: Spinal trauma patients are at high risk for venous thromboembolism (VTE). Objective: To compare the impacts of direct oral anticoagulants (DOACs) and low molecular weight heparin (LMWH) as thromboprophylactic agents on outcomes in operative spinal trauma patients. Methods: A 2-year (2015-2016) retrospective cohort analysis of such patients (spine Abbreviated Injury Scale [AIS] ≥ 3 and other AIS < 3) who received LMWH or DOACs was performed. Propensity score matching (1:2 ratio) followed stratification into two groups. Outcomes included rates of deep vein thrombosis (DVT) and/or pulmonary embolism (PE), packed red blood cell (pRBC) transfusion, operative interventions for spinal cord decompression, and mortality. Results: Of 6036 patients, 810 (270 receiving DOACs; 540 receiving LMWH) were matched. The mean age was 62 ± 15 years, 58% were male, and the median Injury Severity Score was 12 (10-18). Matched groups were similar in demographics, injury parameters, emergency department vital signs, 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%, the overall rate of in-hospital PE was 1.6%, and the mortality rate was 2.5%. DOAC patients were less likely to develop DVT (1.8% vs 7.4%) and PE (0.3% vs 2.1%). There were no differences in postprophylaxis pRBC transfusion requirements, postprophylaxis decompressive procedures on the spinal cord, or mortality. Conclusion: 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 patients.

AB - Essentials Operative spine trauma patients are at increased risk of venous thromboembolism (VTE). Direct oral anticoagulants (DOACs) may have a favorable efficacy and safety in spine trauma. Patients on DOACs had lower rates of VTE in comparison to low molecular weight heparin. DOACs did not augment the risk of surgical bleeding (transfusion, decompressive procedures). Background: Spinal trauma patients are at high risk for venous thromboembolism (VTE). Objective: To compare the impacts of direct oral anticoagulants (DOACs) and low molecular weight heparin (LMWH) as thromboprophylactic agents on outcomes in operative spinal trauma patients. Methods: A 2-year (2015-2016) retrospective cohort analysis of such patients (spine Abbreviated Injury Scale [AIS] ≥ 3 and other AIS < 3) who received LMWH or DOACs was performed. Propensity score matching (1:2 ratio) followed stratification into two groups. Outcomes included rates of deep vein thrombosis (DVT) and/or pulmonary embolism (PE), packed red blood cell (pRBC) transfusion, operative interventions for spinal cord decompression, and mortality. Results: Of 6036 patients, 810 (270 receiving DOACs; 540 receiving LMWH) were matched. The mean age was 62 ± 15 years, 58% were male, and the median Injury Severity Score was 12 (10-18). Matched groups were similar in demographics, injury parameters, emergency department vital signs, 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%, the overall rate of in-hospital PE was 1.6%, and the mortality rate was 2.5%. DOAC patients were less likely to develop DVT (1.8% vs 7.4%) and PE (0.3% vs 2.1%). There were no differences in postprophylaxis pRBC transfusion requirements, postprophylaxis decompressive procedures on the spinal cord, or mortality. Conclusion: 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 patients.

KW - direct oral anticoagulants

KW - low molecular weight heparin

KW - spinal trauma

KW - thromboprophylaxis

KW - venous thromboembolism

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