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Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery

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Abstract

Aim: To determine the risk of postoperative hemorrhage during a 3-year period of early postoperative administration of nadroparin (Fraxiparin) plus compression stockings in a large cohort of patients who underwent spinal surgery. Methods: A total of 1,954 spinal procedures at different levels (503 cervical, 152 thoracic and 1,299 lumbar), performed between June 1999 and 2002 at the Department of Neurosurgery, Johann-Wolfgang-Goethe University Frankfurt, were included in this study. To prevent venous thromboembolic events (VTE), all patients were routinely treated subcutaneously with 0.3 ml of early (less than 24 h) postoperative nadroparin calcium (Fraxiparin) (2850 IU anti-Xa, Sanofi Winthrop Industrie, France) plus intra- and postoperative compression stockings until discharge. The occurrence of a postoperative hematoma (defined as a hematoma requiring surgical evacuation because of space occupation and/or neurological deterioration) and a deep venous thrombosis (DVT) were recorded in a database and analyzed retrospectively. Results: 13 (0.7%) of the 1,954 spinal operations were complicated by major postoperative hemorrhages. In 5 of the 13 patients (38.5%) the hemorrhage occurred on the day of surgery before the administration of nadroparin. Thus, the hemorrhage rate of patients receiving nadroparin was 0.4% (8/1,949). Ten (77%) of the 13 patients with major postoperative hematoma showed a progressive neurological deficit, which resolved in 6 patients and resulted in a hematoma-related morbidity of 31% (4/13). Only 1 patient (0.05%) in this series developed a clinically evident DVT, and none of the patients suffered from pulmonary embolus during the hospital stay. Conclusion: Although retrospective, this is to date the largest study providing information about the hemorrhage rate associated with early postoperative anticoagulation following spinal surgery. The results confirm that early postoperative pharmacological thromboembolic prophylaxis using nadroparin in patients with spinal surgery is not associated with an increased risk of postoperative hemorrhage.

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References

  1. Arai Y, Shitoto K, Muta T, Kurosawa H (1999) Pulmonary thromboembolism after spinal instrumentation surgery. J Orthop Sci 4 5:380–383

    Article  Google Scholar 

  2. Barradell LB, Buckley MM (1992) Nadroparin calcium. A review of its pharmacology and clinical applications in the prevention and treatment of thromboembolic disorders. Drugs 44 5:858–888

    Google Scholar 

  3. Cabana F, Pointillart V, Vital J, Senegas J (2000) [Postoperative compressive spinal epidural hematomas. 15 cases and a review of the literature]. Rev Chir Orthop Reparatrice Appar Mot 86 4:335–345

    Google Scholar 

  4. Catre MG (1997) Anticoagulation in spinal surgery. A critical review of the literature. Can J Surg 40 6:413–419

    Google Scholar 

  5. Clagett GP, Reisch JS (1988) Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg 208 2:227–240

    Google Scholar 

  6. Collignon F, Frydman A, Caplain H, Ozoux ML, Le Roux Y, Bouthier J, Thebault JJ (1995) Comparison of the pharmacokinetic profiles of three low molecular mass heparins - dalteparin, enoxaparin and nadroparin - administered subcutaneously in healthy volunteers (doses for prevention of thromboembolism). Thromb Haemost 73 4:630–640

    Google Scholar 

  7. Collins R, Scrimgeour A, Yusuf S, Peto R (1988) Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. N Engl J Med 318 18:1162–1173

    Google Scholar 

  8. Davis R, Faulds D (1997) Nadroparin calcium. A review of its pharmacology and clinical use in the prevention and treatment of thromboembolic disorders. Drugs Aging 10 4:299–322

    Google Scholar 

  9. Ferree BA, Stern PJ, Jolson RS, Roberts JM, Kahn A III (1993) Deep venous thrombosis after spinal surgery. Spine 18 3:315–319

    Google Scholar 

  10. Ferree BA, Wright AM (1993) Deep venous thrombosis following posterior lumbar spinal surgery. Spine 18 8:1079–1082

    Google Scholar 

  11. Haas S (1993) European consensus statement on the prevention of venous thromboembolism. European Consensus Conference, Windsor, UK, November, 1991. Blood Coagul Fibrinolysis 4 Suppl 1:5–8; discussion S9–10

    Google Scholar 

  12. Haas SB, Tribus CB, Insall JN, Becker MW, Windsor RE (1992) The significance of calf thrombi after total knee arthroplasty. J Bone Joint Surg Br 74 6:799–802

    Google Scholar 

  13. Kakkar VV, Boeckl O, Boneu B, Bordenave L, Brehm OA, Brucke P, Coccheri S, Cohen AT, Galland F, Haas S, Jarrige J, Koppenhagen K, LeQuerrec A, Parraguette E, Prandoni P, Roder JD, Roos M, Ruschemeyer C, Siewert JR, Vinazzer H et al (1997) Efficacy and safety of a low-molecular-weight heparin and standard unfractionated heparin for prophylaxis of postoperative venous thromboembolism: European multicenter trial. World J Surg 21 1:2-8

    Article  Google Scholar 

  14. Kakkar VV, Djazaeri B, Fok J, Fletcher M, Scully MF, Westwick J (1982) Low-molecular-weight heparin and prevention of postoperative deep vein thrombosis. Br Med J (Clin Res Ed) 284 6313:375–379

    Google Scholar 

  15. Kakkar VV, Murray WJ (1985) Efficacy and safety of low-molecular-weight heparin (CY216) in preventing postoperative venous thrombo-embolism: a co-operative study. Br J Surg 72 10:786–791

    Google Scholar 

  16. Kakkar VV, Stringer MD (1990) Prophylaxis of venous thromboembolism. World J Surg 14 5:670–678

    Google Scholar 

  17. Lee HM, Suk KS, Moon SH, Kim DJ, Wang JM, Kim NH (2000) Deep vein thrombosis after major spinal surgery: incidence in an East Asian population. Spine 25 14:1827–1830

    Article  Google Scholar 

  18. Oda T, Fuji T, Kato Y, Fujita S, Kanemitsu N (2000) Deep venous thrombosis after posterior spinal surgery. Spine 25 22:2962–2967

    Article  Google Scholar 

  19. Palmer JD, Sparrow OC, Iannotti F (1994) Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery 35 6:1061–1064

    Google Scholar 

  20. Smith MD, Bressler EL, Lonstein JE, Winter R, Pinto MR, Denis F (1994) Deep venous thrombosis and pulmonary embolism after major reconstructive operations on the spine. A prospective analysis of three hundred and seventeen patients. J Bone Joint Surg Am 76 7:980–985

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Johann-Wolfgang-Goethe University, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany

    Rüdiger Gerlach, Andreas Raabe, Jürgen Beck, Alina Woszczyk & Volker Seifert

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  1. Rüdiger Gerlach
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  2. Andreas Raabe
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  3. Jürgen Beck
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  4. Alina Woszczyk
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  5. Volker Seifert
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Correspondence to Rüdiger Gerlach.

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Disclosure: The authors have no financial interest in the methodology advanced by this study. This study was not supported by Sanofi Winthrop Industrie, France

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Gerlach, R., Raabe, A., Beck, J. et al. Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery. Eur Spine J 13, 9–13 (2004). https://doi.org/10.1007/s00586-003-0642-8

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  • DOI: https://doi.org/10.1007/s00586-003-0642-8

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