Is Blood Loss Greater in Elderly Patients under Antiplatelet or Anticoagulant Medication for Cervical Spine Injury Surgery? A Japanese Multicenter Survey.
antiplatelet/anticoagulant drugs
blood loss volume
cervical spine injury
comorbidity
elderly patients
Journal
Spine surgery and related research
ISSN: 2432-261X
Titre abrégé: Spine Surg Relat Res
Pays: Japan
ID NLM: 101718059
Informations de publication
Date de publication:
2022
2022
Historique:
received:
09
09
2021
accepted:
18
11
2021
entrez:
2
9
2022
pubmed:
3
9
2022
medline:
3
9
2022
Statut:
epublish
Résumé
In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly. The present multicenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma. The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well. Of the 776 patients (mean age: 75.1±6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases. This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly.
Identifiants
pubmed: 36051672
doi: 10.22603/ssrr.2021-0183
pmc: PMC9381072
doi:
Types de publication
Journal Article
Langues
eng
Pagination
366-372Informations de copyright
Copyright © 2022 by The Japanese Society for Spine Surgery and Related Research.
Déclaration de conflit d'intérêts
Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.
Références
Eur Spine J. 2016 Mar;25(3):732-9
pubmed: 25757534
Spine (Phila Pa 1976). 2011 Nov 15;36(24):E1568-72
pubmed: 21289591
Neurosurgery. 2016 Sep;79(3):418-25
pubmed: 27306716
Paraplegia. 1994 Jan;32(1):3-8
pubmed: 8015833
Spine J. 2003 Mar-Apr;3(2):125-9
pubmed: 14589226
J Trauma. 2003 Dec;55(6):1070-6
pubmed: 14676653
JAMA. 2015 Jun 9;313(22):2236-43
pubmed: 26057284
J Am Geriatr Soc. 2015 Oct;63(10):2036-42
pubmed: 26456855
J Neurotrauma. 2014 Feb 1;31(3):228-38
pubmed: 24138672
J Intern Med. 2005 May;257(5):399-414
pubmed: 15836656
Spine (Phila Pa 1976). 2002 Aug 1;27(15):1670-3
pubmed: 12163731
J Am Geriatr Soc. 2017 May;65(5):909-915
pubmed: 27910090
Eur J Trauma Emerg Surg. 2013 Oct;39(5):469-76
pubmed: 26815442
Eur Spine J. 2014 Aug;23(8):1777-82
pubmed: 24740280