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Nice paper from the Rothman group re chemical prophylaxis after spine surgery. The risk of postoperative hematoma is always there. From the paper "our findings suggest that the delayed chemoprophylaxis protocol may mitigate postoperative hematoma formation without increasing the risk for a thrombotic event". This is what I do, lovenox for high risk only and not immediate. Ideally ambulate with mechanical prophylaxis. https://lnkd.in/gPiyqPRk
On the flip side, the morbidity/mortality of a postop hematoma is far lower than that of a saddle PE. We certainly need more data on the topic.
Mechanical prophylaxis for 1st 48 hours then LMWH for high risk patients. No reoperations for haematoma and no recorded VTE episodes. Find this safest.
Interesting and highly relevent! We do LMW heparin (Clexane) 40mg six hours postop for all cases unless bleeding disorder present and we currently review our results with VTE - thanks for providing a good benchmark wirh this paper!
Thank you for sharing this! We have experienced one incident where patient developed a retroperitoneal hematoma (~300cc) following an L45 OLIF-ATP fusion on POD-2 as he restarted his prophylaxis. Fortunately, we did not have to re-operate on him and the hematoma subsided over time!
We start day 1 postop and see less bleeding and actually nog increase in VTE! Relevant paper! I agree Martin N Stienen
Academy Professor of Neurosurgery / Senior Neurosurgeon
1moNice paper Lali. I used Na heparin 5000 U SC BD starting 8 hours post op until discharge with intra op TEDS+SCDs and TEDs 2 weeks. I see they gave TDS and the NS gave it immediately post op. "In the orthopaedic spine protocol (referred to as “delayed” for the rest of this manuscript), patients receive subcutaneous heparin 5000 units every 8 hours starting at 9AM on postoperative day (POD)-1 for all decompressions with or without fusions below cord level (ie, L3 to pelvis) and 9AM POD-2 for any decompressions involving the spinal cord level (ie, L2 and above). In the neurosurgical protocol (referred to as “immediate”), all patients receive subcutaneous heparin 5000 units every 8 hours starting immediately after surgery (POD-0) in the postanesthesia care unit (typically within 1 hour of surgery completion) regardless of operative level. "