29. Early postoperative anticoagulation after spinal fracture surgery decreases venous thromboembolism rates

Abstract

<h3>BACKGROUND CONTEXT</h3> Prophylactic anticoagulation effectively lowers venous thromboembolism (VTE) after operative treatment of spinal fractures. Optimal initiation has not been fully described. Early anticoagulation has been presumed to increase bleeding and wound complications. In 2017, our institutional protocol began initiating VTE chemoprophylaxis 72 hours after operative spinal fixation. <h3>PURPOSE</h3> The purpose of the study was to compare VTE rates and bleeding complications for early (within 72h) vs late (no prophylaxis or after 10-14 days) chemoprophylaxis timing after spinal fracture operative intervention. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study at University of Kansas Medical Center. <h3>PATIENT SAMPLE</h3> Trauma patients 18 years or older treated for spinal fractures who received postoperative anticoagulation between May 2015 and June 2019. <h3>OUTCOME MEASURES</h3> Postoperative bleeding and VTE complications. <h3>METHODS</h3> A review of patients treated for spinal fractures that received anticoagulation chemoprophylaxis administration between May 2015 and June 2019 were studied. Chemoprophylaxis initiation timing (early vs late) was the primary grouping variable. Patients with GCS<13 or evidence of intracranial or intraspinal bleed were excluded. Demographics, injury mechanisms, operative procedures, timing of administration of VTE prophylaxis, injury severity score (ISS) and spine abbreviated injury scale (AIS), and complications including VTE and bleeding complications were collected. Predictors of VTE and bleeding complications were identified using a bivariate analysis. <h3>RESULTS</h3> One-hundred patients (74M, 26F) met inclusion criteria. Median age was 54 years, and median ISS was 13. The early group had 68 patients and the late group had 32. Ten patients developed VTE (7 late, 3 early, P=0.007). Three patients developed bleeding complications, and all occurred in the late group (P=0.010). ISS (P=0.024) and AIS (P=0.017) also correlated with increased VTE rate. <h3>CONCLUSIONS</h3> Chemoprophylactic anticoagulation within 72 hours in surgically treated spinal fracture patients reduces VTE rates without increasing complications. VTE prophylaxis can be initiated at 72 hours following spine fixation to decrease postinjury morbidity and mortality in this high-risk patient population. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.