脊柱外科手术后预防静脉血栓栓塞症的共识与争议
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摘要
静脉血栓栓塞症包括深静脉血栓和肺栓塞,是脊柱外科手术后不容忽视的并发症。其预防措施包括基本预防、物理预防、药物预防及下腔静脉滤器置入。但目前并没有系统的预防指南指导临床工作。考虑到药物预防可能增加术后出血性并发症的风险,诸多学者对其使用的必要性及安全性存在争议。本文对目前脊柱术后预防静脉血栓栓塞症存在的共识和争议做一综述,旨在平衡患者的获益与风险,寻找最优方案。
Venous thromboembolism includes deep venous thrombosis and pulmonary thromboembolism, which cannot be ignored after spinal surgery. Prevention of venous thromboembolism includes basic prophylaxis, physical prophylaxis, medical prophylaxis and inferior vena cava filter. However, there is no systematic clinical guideline for prophylaxis. Considering for the potential risk of bleeding complications resulting from medical prophylaxis, scholars have different views on the necessity and safety of using it. This review will give a comprehensive introduction of consensus and controversy, to balance patients' benefits and risks and try to find an optimal method to prevent venous thromboembolism.
Venous thromboembolism includes deep venous thrombosis and pulmonary thromboembolism, which cannot be ignored after spinal surgery. Prevention of venous thromboembolism includes basic prophylaxis, physical prophylaxis, medical prophylaxis and inferior vena cava filter. However, there is no systematic clinical guideline for prophylaxis. Considering for the potential risk of bleeding complications resulting from medical prophylaxis, scholars have different views on the necessity and safety of using it. This review will give a comprehensive introduction of consensus and controversy, to balance patients' benefits and risks and try to find an optimal method to prevent venous thromboembolism.
引文
[1]张建政,孙天胜,刘智,等.骨科围手术期致死性肺栓塞的特点.中华矫形外科杂志,2009,18(17):1375-1357.
[2]中华医学会骨科分会.中国骨科大手术静脉血栓栓塞症预防指南.中华关节外科杂志(电子版),2009,3(3):380-383.
[3]田伟.中国骨科大手术静脉血栓栓塞症预防指南.中华骨科杂志,2016,36(2):65-71.
[4]Glotzbecker MP,Bono CM,Wood KB,et al.Thromboembolic disease in spinal surgery:a systematic review.Spine(Phila Pa1976),2009,34(3):291-303.
[5]Yamaguchi T,Hasegawa M,Niimi R,et al.Incidence and time course of asymptomatic deep vein thrombosis with fondaparinux in patients undergoing total joint arthroplasty.Thromb Res,2010,126(4):e323-326.
[6]Schizas C,Neumayer F,Kosmopoulos V.Incidence and management of pulmonary embolism following spinal surgery occurring while under chemical thromboprophylaxis.Eur Spine J,2008,17(7):970-974.
[7]Committee NE-BGD.Evidence-based clinical guidelines for multidisciplinary spine aare.Antithrombotic therapies in spine surgery.2009,Burr Ridge,IL:North American Spine Society.
[8]Schoenfeld AJ,Herzog JP,Dunn JC,et al.Patient-based and surgical characteristics associated with the acute develop‐ment of deep venous thrombosis and pulmonary embolism after spine surgery.Spine(Phila Pa1976),2013,38(21):1892-1898.
[9]Schulte LM,O'Brien JR,Bean MC,et al.Deep vein thrombosis and pulmonary embolism after spine surgery:incidence and patient risk factors.Am J Orthop(Belle Mead NJ),2013,42(6):267-270.
[10]Kim HJ,Walcott-Sapp S,Adler RS,et al.Thromboembolic complications following spine surgery assessed with spiral CT scans:DVT/PE following spine surgery.Hss J,2011,7(1):37-40.
[11]McClendon J Jr,O.shaughnessy BA,Smith TR,et al.Comprehensive assessment of prophylactic preoperative inferior vena cava filters for major spinal reconstruction in adults.Spine(Phila Pa1976),2012,37(13):1122-1129.
[12]Caprini JA.Risk assessment as a guide to thrombosis prophylaxis[J].Cur Opin Pulm Med,2010,16(5):448-452.
[13]Akeda K,Matsunaga H,Imanishi T,et al.Prevalence and countermeasures for venous thromboembolic diseases associated with spinal surgery:a follow-up study of an institutional protocol in 209 patients.Spine(Phila Pa1976),2014,39(10):791-797.
[14]Ferree BA,Wright AM.Deep venous thrombosis following posterior lumbar spinal surgery.Spine(Phila Pa1976),1993,18(8):1079-1082.
[15]Puymiraté,Aissaoui N,Silvain J,et al.Comparison of bleeding complications and 3-year survival with low-molecularweight heparin versus unfractionated heparin for acute myocardial infarction:the FAST-MI registry.Arch Cardiovasc Dis,2012,105(6-7):347-354.
[16]Warkentin TE,Levine MN,Hirsh J,et al.Heparin-induced thrombocytopenia in patients treated with low-molecularweight heparin or unfractionated heparin.N Engl J,1995,332(20):1330-1335.
[17]Kakkar VV,Boeckl O,Boneu B,et al.Efficacy and safety of a low-molecular-weight heparin and standard unfractionated heparin for prophylaxis of postoperative venous thromboembolism:European multicenter trial.World J Surg,1997,21(1):2-9.
[18]Birkmeyer NJ,Finks JF,Carlin AM,et al.Comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery.Arch Surg,2012,147(11):994-998.
[19]Moayer A,Mohebali N,Razmkon A.Incidence of deep vein thrombosis in patients undergoing degenerative spine surgery on prophylactic dalteparin;a single center report.Bull Emerg Trauma,2016,4(1):38-42.
[20]Zhi-jian S,Yu Z,Giu-xing Q,et al.Efficacy and safety of low molecular weight heparin prophylaxis for venous thromboembolism following lumbar decompression surgery.Chin Med Sci J,2011,26(4):221-226.
[21]Guo Y,Zou Z,Jia L,et al.Safety and effectiveness of argatroban versus heparin for preventing venous thromboembolism after lumbar decompressive surgery.Int J Surg,2017,44:324-328.
[22]Agnelli G,Piovella F,Buoncristiani P,et al.Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery.N Engl J Med,1998,339(2):80-85.
[23]Strom RG,Frempong-Boadu AK.Low-molecular-weight heparin prophylaxis 24 to 36 hours after degenerative spine surgery:risk of hemorrhage and venous thromboembolism.Spine,2013,38(23):1498-1502.
[24]Gerlach R,Raabe A,Beck J,et al.Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery.Eur Spine J,2004,13(1):9-13.
[25]Wei D,Zhao C,Wang J,et al.Comparison of rivaroxaban and parnaparin for preventing venous thromboembolism after lumbar spine surgery.J Orthop Surg Res,2015,10(1):1-8.
[26]Morse K,Weight M,Molinari R.Extensive postoperative epidural hematoma after full anticoagulation:case report and review of the literature.J Spinal Cord Med,2007,30(3):282-287.
[27]Glotzbecker MP,Bono CM,Wood KB,et al.Postoperative spinal epidural hematoma:a systematic review.Spine(Phila Pa1976),2010,35(10):E413-420.
[28]Ferree BA,Stern PJ,Jolson RS.Deep venous thrombosis after spinal surgery.Spine(Phila Pa1976),1993,18(3):315-319.
[29]Ozturk C,Ganiyusufoglu K,Alanay A,et al.Efficacy of prophylactic placement of inferior vena cava filter in patients undergoing spinal surgery.Spine(Phila Pa1976),2010,35(20):1893-1896.
[30]Epstein NE.Prophylactic inferior vena cava filter placement prior to lumbar surgery in morbidly obese patients:Twocase study and literature review.Surg Neurol Int,2015,6(Suppl 19):S469-474.
[31]Leon L,Rodriguez H,Tawk RG,et al.The prophylactic use of inferior vena cava filters in patients undergoing high-risk spinal surgery.Ann Vasc Surg,2005,19(3):442-447.
[32]Dazley JM,Wain R,Vellinga RM,et al.Prophylactic inferior vena cava filters prevent pulmonary embolisms in highrisk patients undergoing major spinal surgery.J Spinal Disord Tech,2012,25(4):190-195.
[33]Becker DM,Philbrick JT,Selby JB.Inferior vena cava filters.Indications,safety,effectiveness.Arch Intern Med,1992,152(10):1985-1994.
[34]Kuklo T,Rosner M,Ondra SL,et al.Preoperative inferior vena cava filters for major spinal reconstruction in adults.In:Scoliosis Research Society 43rd Annual Meeting&Course,2008,Salt Lake City,UT.
[35]Haga M,Hosaka A,Miyahara T,et al.Penetration of an inferior vena cava filter into the aorta.Ann Vasc Dis,2014,7(4):413-416.
[2]中华医学会骨科分会.中国骨科大手术静脉血栓栓塞症预防指南.中华关节外科杂志(电子版),2009,3(3):380-383.
[3]田伟.中国骨科大手术静脉血栓栓塞症预防指南.中华骨科杂志,2016,36(2):65-71.
[4]Glotzbecker MP,Bono CM,Wood KB,et al.Thromboembolic disease in spinal surgery:a systematic review.Spine(Phila Pa1976),2009,34(3):291-303.
[5]Yamaguchi T,Hasegawa M,Niimi R,et al.Incidence and time course of asymptomatic deep vein thrombosis with fondaparinux in patients undergoing total joint arthroplasty.Thromb Res,2010,126(4):e323-326.
[6]Schizas C,Neumayer F,Kosmopoulos V.Incidence and management of pulmonary embolism following spinal surgery occurring while under chemical thromboprophylaxis.Eur Spine J,2008,17(7):970-974.
[7]Committee NE-BGD.Evidence-based clinical guidelines for multidisciplinary spine aare.Antithrombotic therapies in spine surgery.2009,Burr Ridge,IL:North American Spine Society.
[8]Schoenfeld AJ,Herzog JP,Dunn JC,et al.Patient-based and surgical characteristics associated with the acute develop‐ment of deep venous thrombosis and pulmonary embolism after spine surgery.Spine(Phila Pa1976),2013,38(21):1892-1898.
[9]Schulte LM,O'Brien JR,Bean MC,et al.Deep vein thrombosis and pulmonary embolism after spine surgery:incidence and patient risk factors.Am J Orthop(Belle Mead NJ),2013,42(6):267-270.
[10]Kim HJ,Walcott-Sapp S,Adler RS,et al.Thromboembolic complications following spine surgery assessed with spiral CT scans:DVT/PE following spine surgery.Hss J,2011,7(1):37-40.
[11]McClendon J Jr,O.shaughnessy BA,Smith TR,et al.Comprehensive assessment of prophylactic preoperative inferior vena cava filters for major spinal reconstruction in adults.Spine(Phila Pa1976),2012,37(13):1122-1129.
[12]Caprini JA.Risk assessment as a guide to thrombosis prophylaxis[J].Cur Opin Pulm Med,2010,16(5):448-452.
[13]Akeda K,Matsunaga H,Imanishi T,et al.Prevalence and countermeasures for venous thromboembolic diseases associated with spinal surgery:a follow-up study of an institutional protocol in 209 patients.Spine(Phila Pa1976),2014,39(10):791-797.
[14]Ferree BA,Wright AM.Deep venous thrombosis following posterior lumbar spinal surgery.Spine(Phila Pa1976),1993,18(8):1079-1082.
[15]Puymiraté,Aissaoui N,Silvain J,et al.Comparison of bleeding complications and 3-year survival with low-molecularweight heparin versus unfractionated heparin for acute myocardial infarction:the FAST-MI registry.Arch Cardiovasc Dis,2012,105(6-7):347-354.
[16]Warkentin TE,Levine MN,Hirsh J,et al.Heparin-induced thrombocytopenia in patients treated with low-molecularweight heparin or unfractionated heparin.N Engl J,1995,332(20):1330-1335.
[17]Kakkar VV,Boeckl O,Boneu B,et al.Efficacy and safety of a low-molecular-weight heparin and standard unfractionated heparin for prophylaxis of postoperative venous thromboembolism:European multicenter trial.World J Surg,1997,21(1):2-9.
[18]Birkmeyer NJ,Finks JF,Carlin AM,et al.Comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery.Arch Surg,2012,147(11):994-998.
[19]Moayer A,Mohebali N,Razmkon A.Incidence of deep vein thrombosis in patients undergoing degenerative spine surgery on prophylactic dalteparin;a single center report.Bull Emerg Trauma,2016,4(1):38-42.
[20]Zhi-jian S,Yu Z,Giu-xing Q,et al.Efficacy and safety of low molecular weight heparin prophylaxis for venous thromboembolism following lumbar decompression surgery.Chin Med Sci J,2011,26(4):221-226.
[21]Guo Y,Zou Z,Jia L,et al.Safety and effectiveness of argatroban versus heparin for preventing venous thromboembolism after lumbar decompressive surgery.Int J Surg,2017,44:324-328.
[22]Agnelli G,Piovella F,Buoncristiani P,et al.Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery.N Engl J Med,1998,339(2):80-85.
[23]Strom RG,Frempong-Boadu AK.Low-molecular-weight heparin prophylaxis 24 to 36 hours after degenerative spine surgery:risk of hemorrhage and venous thromboembolism.Spine,2013,38(23):1498-1502.
[24]Gerlach R,Raabe A,Beck J,et al.Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery.Eur Spine J,2004,13(1):9-13.
[25]Wei D,Zhao C,Wang J,et al.Comparison of rivaroxaban and parnaparin for preventing venous thromboembolism after lumbar spine surgery.J Orthop Surg Res,2015,10(1):1-8.
[26]Morse K,Weight M,Molinari R.Extensive postoperative epidural hematoma after full anticoagulation:case report and review of the literature.J Spinal Cord Med,2007,30(3):282-287.
[27]Glotzbecker MP,Bono CM,Wood KB,et al.Postoperative spinal epidural hematoma:a systematic review.Spine(Phila Pa1976),2010,35(10):E413-420.
[28]Ferree BA,Stern PJ,Jolson RS.Deep venous thrombosis after spinal surgery.Spine(Phila Pa1976),1993,18(3):315-319.
[29]Ozturk C,Ganiyusufoglu K,Alanay A,et al.Efficacy of prophylactic placement of inferior vena cava filter in patients undergoing spinal surgery.Spine(Phila Pa1976),2010,35(20):1893-1896.
[30]Epstein NE.Prophylactic inferior vena cava filter placement prior to lumbar surgery in morbidly obese patients:Twocase study and literature review.Surg Neurol Int,2015,6(Suppl 19):S469-474.
[31]Leon L,Rodriguez H,Tawk RG,et al.The prophylactic use of inferior vena cava filters in patients undergoing high-risk spinal surgery.Ann Vasc Surg,2005,19(3):442-447.
[32]Dazley JM,Wain R,Vellinga RM,et al.Prophylactic inferior vena cava filters prevent pulmonary embolisms in highrisk patients undergoing major spinal surgery.J Spinal Disord Tech,2012,25(4):190-195.
[33]Becker DM,Philbrick JT,Selby JB.Inferior vena cava filters.Indications,safety,effectiveness.Arch Intern Med,1992,152(10):1985-1994.
[34]Kuklo T,Rosner M,Ondra SL,et al.Preoperative inferior vena cava filters for major spinal reconstruction in adults.In:Scoliosis Research Society 43rd Annual Meeting&Course,2008,Salt Lake City,UT.
[35]Haga M,Hosaka A,Miyahara T,et al.Penetration of an inferior vena cava filter into the aorta.Ann Vasc Dis,2014,7(4):413-416.