Operative spinal trauma: Thromboprophylaxis with low molecular weight heparin or a direct oral anticoagulant
Author(s): ,
Mohammad Hamidi
Affiliations:
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson
,
Muhammad Zeeshan
Affiliations:
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson
,
Narong Kulvatunyou
Affiliations:
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson
,
Hari S. Mitra
Affiliations:
Department of Orthopedic Surgery, College of Medicine, University of Arizona, Tucson
,
Kamil Hanna
Affiliations:
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson
,
Andrew Tang
Affiliations:
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson
,
Ashley Northcutt
Affiliations:
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson
,
Terence O'Keeffe
Affiliations:
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson
Bellal Joseph
Affiliations:
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson
Correspondence |Bellal Joseph, Division of Trauma, Critical Care, and Emergency Surgery, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ 85724.|Email: bjoseph@surgery.arizona.edu
ISTH Academy. Joseph . May 31, 2019; 273635
Correspondence |Bellal Joseph

Correspondence
|Bellal  Joseph
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Journal Abstract
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Background
Spinal trauma patients are at high risk for venous thromboembolism (VTE).
Objective
To compare the impacts of direct oral anticoagulants (DOACs) and low molecular weight heparin (LMWH) as thromboprophylactic agents on outcomes in operative spinal trauma patients.
Methods
A 2‐year (2015‐2016) retrospective cohort analysis of such patients (spine Abbreviated Injury Scale [AIS] ≥ 3 and other AIS < 3) who received LMWH or DOACs was performed. Propensity score matching (1:2 ratio) followed stratification into two groups. Outcomes included rates of deep vein thrombosis (DVT) and/or pulmonary embolism (PE), packed red blood cell (pRBC) transfusion, operative interventions for spinal cord decompression, and mortality.
Results
Of 6036 patients, 810 (270 receiving DOACs; 540 receiving LMWH) were matched. The mean age was 62 ± 15 years, 58% were male, and the median Injury Severity Score was 12 (10‐18). Matched groups were similar in demographics, injury parameters, emergency department vital signs, hospital stay, rates of inferior vena cava filter placement, and timing of initiation of thromboprophylaxis. The overall rate of in‐hospital DVT was 5.6%, the overall rate of in‐hospital PE was 1.6%, and the mortality rate was 2.5%. DOAC patients were less likely to develop DVT (1.8% vs 7.4%) and PE (0.3% vs 2.1%). There were no differences in postprophylaxis pRBC transfusion requirements, postprophylaxis decompressive procedures on the spinal cord, or mortality.
Conclusion
In operative spinal trauma patients, thromboprophylaxis with DOACs appears to be associated with lower rates of DVT and PE. Further prospective clinical trials should evaluate the role of DOACs in preventing VTE events in spinal trauma patients.
Keyword(s)
direct oral anticoagulants, low molecular weight heparin, spinal trauma, thromboprophylaxis, venous thromboembolism
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