Lower Mortality and Morbidity with Low-Molecular-Weight Heparin for Venous Thromboembolism Prophylaxis in Spine Trauma. Issue 23 (1st December 2020)

• Record Type: Journal Article
• Authors: Neifert, Sean N.; Chapman, Emily K.; Rothrock, Robert J.; Gilligan, Jeffrey; Yuk, Frank; McNeill, Ian T.; Rasouli, Jonathan J.; Gal, Jonathan S.; Caridi, John M.
• Is Part Of: Spine. Volume 45:Issue 23(2020)
• Publication Date: 2020-12-01
• Subjects: deep vein thrombosis -- heparin -- low molecular weight heparin -- pulmonary embolism -- spine trauma -- unfractionated heparin -- venous thromboembolism prophylaxis; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000003664
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Retrospective review of prospectively collected data. Objective: The objective of this study was to evaluate outcomes between patients receiving LMWH versus UH in a retrospective cohort of patients with spine trauma. Summary of Background Data: Although multiple clinical trials have been conducted, current guidelines do not have enough evidence to suggest low-molecular-weight heparin (LMWH) or unfractionated heparin (UH) for venous thromboembolism (VTE) prophylaxis in spine trauma. Methods: Patients with spine trauma in the Trauma Quality Improvement Program datasets were identified. Those who died, were transferred within 72 hours, were deemed to have a fatal injury, were discharged within 24 hours, suffered from polytrauma, or were missing data for VTE prophylaxis were excluded. A propensity score was created using age, sex, severity of injury, time to prophylaxis, presence of a cord injury, and altered mental status or hypotension upon arrival, and inverse probability weighted logistic regression modeling was used to evaluate mortality, venous thromboembolic, return to operating room, and total complication rates. E values were used to calculate the likelihood of unmeasured confounders. Results: Those receiving UH (n = 7172) were more severely injured ( P < 0.0001), with higher rates of spinal cord injury (32.26% vs. 25.32%, P < 0.0001) and surgical stabilization (29.52% vs. 22.94%, P < 0.0001) compared to those receiving LMWH (n = 20, 341). Patients receiving LMWH had lower mortality (odds ratio [OR]: 0.47; 95% CI: 0.42–0.53; P < 0.001; E = 3.68), total complication (OR: 0.92; 95% CI: 0.88–0.95; P < 0.001; E = 1.39), and VTE event (OR: 0.80; 95% CI: 0.72–0.88; P < 0.001; E = 1.81) rates than patients receiving UH. There were no differences in rates of unplanned return to the operating room (OR: 1.01; 95% CI: 0.80–1.27; P = 0.93; E = 1.11). Conclusion: There is an association between lower mortality and receiving LMWH for VTE prophylaxis in patients with spine trauma. A large randomized clinical trial is necessary to confirm these findings. Level of Evidence: 3 Abstract : Current guidelines do not recommend low-molecular-weight heparin (LMWH) over unfractionated heparin (UH) in spine trauma. We found lower mortality and thromboembolic event rates among spine trauma patients receiving LMWH over UH in an inverse-probability weighted analysis. Statistical analyses suggest a low probability of unmeasured confounders in the mortality analysis.