Management of Anticoagulation/Antiplatelet Medication and Venous Thromboembolism Prophylaxis in Elective Spine Surgery: Concise Clinical Recommendations Based on a Modified Delphi Process.

Autor:	Zuckerman SL; Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN., Berven S; Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA., Streiff MB; Department of Medicine - Hematology, Johns Hopkins Hospital, Baltimore, MD., Kerolus M; Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY., Buchanan IA; Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY., Ha A; Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY., Bonfield CM; Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN., Buchholz AL; Department of Neurological Surgery, University of Virginia, Charlottesville, VA., Buchowski JM; Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO., Burch S; Department of Orthopaedic Surgery, University of San Francisco Health, San Francisco, CA., Devin CJ; Department of Orthopedic Surgery, Steamboat Orthopaedic and Spine Institute, Steamboat Springs, CO., Dimar JR; Department of Orthopedic Surgery, Norton Health Care, Louisville, KY., Gum JL; Department of Orthopedic Surgery, Norton Health Care, Louisville, KY., Good C; Department of Spine Surgery, Virginia Spine Institute, Reston, VA., Kim HJ; Department of Orthopedic Surgery, Hospital of Special Surgery, New York, NY., Kim JS; Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY., Lombardi JM; Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY., Mandigo CE; Department of Neurosurgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY., Bydon M; Department of Neurosurgery, Mayo Clinic, Rochester, MN., Oppenlander ME; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ., Polly DW Jr; Department of Orthopedic Surgery, University of Minnesota Medical Center, Minneapolis, MN., Poulter G; Department of Spine Surgery, OrthoIndy, Indianapolis, IN., Shah SA; Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE., Singh K; Department of Orthopaedic Surgery, Rush University Medical Center., Than KD; Department of Neurosurgery and Orthopaedic Surgery, Duke University, Durham, NC., Spyropoulos AC; Department of Internal Medicine, Northwell Health, New York, NY., Kaatz S; Department of Internal Medicine, Henry Ford Health System, Detroit, MI., Jain A; Department of Neurosurgery and Orthopaedic Surgery, John Hopkins Medicine, Baltimore, MD., Schutzer RW; Department of Vascular Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY., Wang TZ; Department of Infectious Disease, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY., Mazique DC; Department of Internal Medicine, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY., Lenke LG; Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY., Lehman RA; Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY.
Jazyk:	angličtina
Zdroj:	Spine [Spine (Phila Pa 1976)] 2023 Mar 01; Vol. 48 (5), pp. 301-309. Date of Electronic Publication: 2022 Nov 14.
DOI:	10.1097/BRS.0000000000004540
Abstrakt:	Study Design: Delphi method. Objective: To gain consensus on the following questions: (1) When should anticoagulation/antiplatelet (AC/AP) medication be stopped before elective spine surgery?; (2) When should AC/AP medication be restarted after elective spine surgery?; (3) When, how, and in whom should venous thromboembolism (VTE) chemoprophylaxis be started after elective spinal surgery? Summary of Background Data: VTE can lead to significant morbidity after adult spine surgery, yet postoperative VTE prophylaxis practices vary considerably. The management of preoperative AC/AP medication is similarly heterogeneous. Materials and Methods: Delphi method of consensus development consisting of three rounds (January 26, 2021, to June 21, 2021). Results: Twenty-one spine surgeons were invited, and 20 surgeons completed all rounds of questioning. Consensus (>70% agreement) was achieved in 26/27 items. Group consensus stated that preoperative Direct Oral Anticoagulants should be stopped two days before surgery, warfarin stopped five days before surgery, and all remaining AC/AP medication and aspirin should be stopped seven days before surgery. For restarting AC/AP medication postoperatively, consensus was achieved for low-risk/medium-risk/high-risk patients in 5/5 risk factors (VTE history/cardiac/ambulation status/anterior approach/operation). The low/medium/high thresholds were POD7/POD5/POD2, respectively. For VTE chemoprophylaxis, consensus was achieved for low-risk/medium-risk/high-risk patients in 12/13 risk factors (age/BMI/VTE history/cardiac/cancer/hormone therapy/operation/anterior approach/staged separate days/staged same days/operative time/transfusion). The one area that did not gain consensus was same-day staged surgery. The low-threshold/medium-threshold/high-threshold ranges were postoperative day 5 (POD5) or none/POD3-4/POD1-2, respectively. Additional VTE chemoprophylaxis considerations that gained consensus were POD1 defined as the morning after surgery regardless of operating finishing time, enoxaparin as the medication of choice, and standardized, rather than weight-based, dose given once per day. Conclusions: In the first known Delphi study to address anticoagulation/antiplatelet recommendations for elective spine surgery (preoperatively and postoperatively); our Delphi consensus recommendations from 20 spine surgeons achieved consensus on 26/27 items. These results will potentially help standardize the management of preoperative AC/AP medication and VTE chemoprophylaxis after adult elective spine surgery. Competing Interests: J.M.B.: Royalties; Globus Medical, Inc.; Stryker, Inc.; and Wolter Kluwer. The remaining authors report no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu