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Perioperative Anticoagulation Management in Spine Surgery: Initial Findings From the AO Spine Anticoagulation Global Survey
Journal – global spine journal
Publication date – Apr – 2020
Authors – Philip Louie, MD , Garrett Harada, MD , James Harrop, MD , Thomas Mroz, MD , Khalid Al-Saleh, PhD , Giovanni Brodano, MD , Jens Chapman, MD, Michael Fehlings, MD, PhD , Serena Hu, MD , Yoshiharu Kawaguchi, MD, PhD, Michael Mayer, MD, PhD, Venugopal Menon, MD , Jong-Beom Park, PhD, Sheeraz Qureshi, MD, MBA, Shanmuganathan Rajasekaran, PhD, Marcelo Valacco, MD, Luiz Vialle, PhD, Jeffrey C. Wang, MD, Karsten Wiechert, MD, Daniel Riew, MD, and Dino Samartzis, DSc
Keywords – anticoagulation, bridging, guidelines, spine surgery, Survey, thromboprophylaxis
Open access – Yes
Speciality – Neurosurgery
World region Global
Language – English
Submitted to the One Surgery Index on May 31, 2020 at 2:50 pm
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 ¼ 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 (P ¼ .036) and patient body mass index (P ¼ .008) were perceived differently when deciding to begin anticoagulation,
while the importance of medical clearance (P < .001) and reference to literature (P ¼ .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.
OSI Number – 20463