An Algorithmic Approach to Venous Thromboembolism Prophylaxis in Spine Surgery

Journal of Spinal Disorders & Techniques
Scott M EskildsenMoe R Lim

Abstract

Venous thromboembolic embolism (VTE) is a potentially serious and life-threatening complication in spine surgery. However, VTE incidence and prophylaxis in spine surgery remains controversial. Current recommendations for VTE prophylaxis address "spine surgery" as a single broad category and mainly consider patient factors when determining risk. We performed a literature review to determine the varying VTE and bleeding risks within spine surgery to develop an individualized prophylactic algorithm. Our review suggests that the current guidelines on VTE prophylaxis for spine surgery from NASS and ACCP are suboptimal. Consideration of (1) patient-related VTE risks, (2) procedure-related VTE risks, and (3) the risk of neurological compromise from bleeding complications will more appropriately balance safety and effectiveness when choosing a VTE prophylaxis method. To better individualize VTE prophylaxis, we have developed the VTE Prophylaxis Risk/Benefit Score that considers this currently available best evidence to arrive at a recommendation for the most appropriate form of VTE prophylaxis. This algorithm informs the surgeon to help make a more nuanced and individualized determination of prophylaxis.

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Citations

Sep 3, 2016·Journal of Neurosurgery. Spine·Keaton PiperG Edward Vates
Jul 6, 2019·The Journal of Bone and Joint Surgery. American Volume·Hayden B RocksonMichael P Stauff
Jun 3, 2020·Medicine·María J ColominaGerard Urrútia
May 18, 2021·JBJS Reviews·Alexander J Butler, Frank J Eismont

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