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Antithrombotic therapy and spinal surgery: a retrospective cohort study of 289 consecutive elderly patients with degenerative lumbar stenosis – Lumbar Spinal Stenosis

This article published in the Journal of Neurosurgery: Spine discusses the outcomes of surgical procedures for lumbar spinal stenosis (LSS) in patients taking antithrombotic drugs. LSS is a degenerative condition that primarily affects older individuals and results in pain and reduced mobility. Surgical decompression is generally preferred over conservative management, but concerns arise in elderly patients who take anticoagulant or antiplatelet medications due to cardiovascular comorbidities. The study analyzed data from 289 patients aged 65 and older who underwent lumbar decompression surgery. The results indicate that the use of anticoagulant and antiplatelet therapies in elective decompressive surgery may be safe and not associated with early complications. Further research is needed to confirm these findings

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : top day surgery unit in UK

Published article

CONCLUSIONS: The results of this study suggest that the use of anticoagulant and antiplatelet therapies in elective decompressive surgery could be devoid of early complications and could be safely continued perioperatively.

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J Neurosurg Spine. 2023 Oct 27:1-7. doi: 10.3171/2023.8.SPINE221332. Online ahead of print.ABSTRACTOBJECTIVE: Lumbar spinal stenosis (LSS) is a disabling degenerative process of the spine, mainly affecting older patients. LSS manifests with low-back and leg pain and neurogenic claudication. Disability and impairment in activities of daily living are consequences of the progressive narrowing of the lumbar,

J Neurosurg Spine. 2023 Oct 27:1-7. doi: 10.3171/2023.8.SPINE221332. Online ahead of print.

ABSTRACT

OBJECTIVE: Lumbar spinal stenosis (LSS) is a disabling degenerative process of the spine, mainly affecting older patients. LSS manifests with low-back and leg pain and neurogenic claudication. Disability and impairment in activities of daily living are consequences of the progressive narrowing of the lumbar spinal canal. Surgical decompression has been shown to be superior to conservative management. Nonetheless, intraoperative and postoperative blood loss in elderly patients taking antiplatelet or anticoagulant drugs owing to cardiovascular comorbidities may be a special issue. This study describes and compares early outcomes after surgical procedures in different groups of patients receiving antithrombotic drugs.

METHODS: The authors’ study retrospectively recruited 289 consecutive patients aged ≥ 65 years who received lumbar decompression for spinal stenosis between January 2021 and May 2022. First, 183 patients taking antiplatelet therapy were divided into two groups according to the rationale for use: primary versus secondary prophylaxis of cardiovascular events (group 1 vs group 2). Primary prevention was stopped preoperatively, or secondary prevention was not discontinued during the perioperative period. Secondly, 106 patients who were not taking antiplatelet mediation were divided into two groups, depending on whether preoperative low-molecular-weight heparin had not been administered or had been (group A vs group B). Intraoperative blood loss, surgical time, and postoperative hospitalization were analyzed.

RESULTS: No significant statistical differences were observed between groups 1 and 2 in terms of intraoperative blood loss and time of surgery, or between groups A and B in terms of all analyzed variables. No early or delayed complications were observed, perioperatively or during the postoperative 3-month follow-up period.

CONCLUSIONS: The results of this study suggest that the use of anticoagulant and antiplatelet therapies in elective decompressive surgery could be devoid of early complications and could be safely continued perioperatively.

PMID:37890188 | DOI:10.3171/2023.8.SPINE221332

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Antithrombotic therapy and spinal surgery: a retrospective cohort study of 289 consecutive elderly patients with degenerative lumbar stenosis

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J Neurosurg Spine. 2023 Oct 27:1-7. doi: 10.3171/2023.8.SPINE221332. Online ahead of print.ABSTRACTOBJECTIVE: Lumbar spinal stenosis (LSS) is a disabling degenerative process of the spine, mainly affecting older patients. LSS manifests with low-back and leg pain and neurogenic claudication. Disability and impairment in activities of daily living are consequences of the progressive narrowing of the lumbar

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