122. Anticoagulation therapy in cervical spine fractures: insights from a large health care database analysis

Abstract

<h3>BACKGROUND CONTEXT</h3> The type of chemical thromboembolic event (TEE) prophylaxis to administer following cervical spine fracture is a matter of contention. The risk of TEE must be weighed against the risk of bleeding complications from the therapy itself. Patients with cervical fractures may be at greater risk of devastating bleeding complications such as epidural hematoma, particularly after surgical decompression. The goal of this database study was to provide an accurate estimate to serve as a reference in the literature for the incidence of TEE in these patients. <h3>PURPOSE</h3> The purpose of this study was to (1) evaluate comorbidity burden, (2) rate of thromboembolic events, (3) rate of anemia and transfusion events, and (4) evaluate utilization rates of various forms of pharmacologic prophylaxis following cervical spine fracture. <h3>STUDY DESIGN/SETTING</h3> Retrospective database study. <h3>PATIENT SAMPLE</h3> The study included 5,871 patients who were treated with anticoagulation therapy within 6 months of cervical spine fracture identified from the Humana Insurance Database. <h3>OUTCOME MEASURES</h3> (1) Thromboembolic events, (2) transfusion proportion, and (3) anemia proportion, based on various types of AC therapy. <h3>METHODS</h3> A retrospective review of the Humana insurance database from 2007 to 2016 was performed to identify patients who sustained a fracture of the cervical spine and prescribed anticoagulation therapy. Patients were subdivided by the type of agent prescribed: aspirin/anti platelet therapy, warfarin, heparin/low molecular weight heparin (LMWH), or factor Xa inhibitors. Each cohort was longitudinally tracked for 6 months following surgery for occurrence of deep venous thrombosis (DVT), pulmonary embolism (PE), stroke, anemia or blood transfusion. Chi-square test was used to determine significance. <h3>RESULTS</h3> A total of 5,871 patients were included. Demographics of each cohort were statistically similar. Patients receiving warfarin had a greater CCI compared to the other cohorts (4.1; p < 0.05). Patients on aspirin/anti-platelet therapy were the least likely to develop any TEE (2.1%; p < 0.05). There was no statistically significant difference found between cohorts in regard to the incidence of stroke, transfusion rate or anemia. <h3>CONCLUSIONS</h3> Aspirin and anti-platelet anticoagulation therapy after cervical fracture had the least number of thromboembolic events when used within 6 months compared to other common forms of anticoagulation, without any statistically significant difference in bleeding risk. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.