Is Blood Loss Greater in Elderly Patients under Antiplatelet or Anticoagulant Medication for Cervical Spine Injury Surgery? A Japanese Multicenter Survey.

Autor:	Uehara M; Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan., Ikegami S; Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan., Takizawa T; Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan., Oba H; Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan., Yokogawa N; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa, Japan., Sasagawa T; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa, Japan.; Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, Toyama, Japan., Ando K; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan., Nakashima H; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan., Segi N; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan., Funayama T; Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan., Eto F; Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan., Yamaji A; Department of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital, Sashima, Japan., Watanabe K; Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan., Nori S; Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan., Takeda K; Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.; Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan., Furuya T; Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba, Japan., Orita S; Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba, Japan.; Chiba University Center for Frontier Medical Engineering (CFME), Chiba, Japan., Nakajima H; Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Yoshida, Japan., Yamada T; Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.; Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital, Nagoya, Japan., Hasegawa T; Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan., Terashima Y; Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan.; Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital, Sapporo, Japan., Hirota R; Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan., Suzuki H; Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan., Imajo Y; Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan., Tonomura H; Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan., Sakata M; Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.; Department of Orthopaedics, Saiseikai Shiga Hospital, Shiga, Japan., Hashimoto K; Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan., Onoda Y; Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan., Kawaguchi K; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan., Haruta Y; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan., Suzuki N; Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan., Kato K; Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan., Uei H; Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan.; Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan., Sawada H; Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan., Nakanishi K; Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Kurashiki, Japan., Misaki K; Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Kurashiki, Japan., Terai H; Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan., Tamai K; Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan., Shirasawa E; Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan., Inoue G; Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan., Kakutani K; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan., Kakiuchi Y; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan., Kiyasu K; Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan., Tominaga H; Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan., Tokumoto H; Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan., Iizuka Y; Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan., Takasawa E; Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan., Akeda K; Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan., Takegami N; Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan., Funao H; Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan.; Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita, Japan.; Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan., Oshima Y; Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan., Kaito T; Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan., Sakai D; Department of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan., Yoshii T; Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan., Ohba T; Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan., Otsuki B; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Seki S; Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan., Miyazaki M; Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan., Ishihara M; Department of Orthopaedic Surgery, Kansai Medical University Hospital, Hirakata, Japan., Okada S; Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan., Aoki Y; Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan., Harimaya K; Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, Beppu, Japan., Murakami H; Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan., Ishii K; Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan.; Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita, Japan.; Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan., Ohtori S; Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba, Japan., Imagama S; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan., Kato S; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa, Japan.
Jazyk:	angličtina
Zdroj:	Spine surgery and related research [Spine Surg Relat Res] 2021 Dec 27; Vol. 6 (4), pp. 366-372. Date of Electronic Publication: 2021 Dec 27 (Print Publication: 2022).
DOI:	10.22603/ssrr.2021-0183
Abstrakt:	Introduction: In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly. The present multicenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma. Methods: The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well. Results: Of the 776 patients (mean age: 75.1±6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases. Conclusions: This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly. Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest. (Copyright © 2022 by The Japanese Society for Spine Surgery and Related Research.)
Databáze:	MEDLINE
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