The Practice of Continuation of Anti Platelet Therapy During the Peri-Operative Period in Lumbar Minimally Invasive Spine Surgery (MISS): How Different is the Morbidity in This Scenario?

STUDY DESIGN.Cohort. OBJECTIVE.To evaluate peri-operative morbidity in patients undergoing minimally invasive spine surgery (MISS) of the lumbar spine while continuing the anti-platelet drug (APD) peri-operatively as compared to those not continuing these drugs and those not on these drugs. SUMMARY...

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Published in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 2019-12
Main Authors: Kulkarni, Arvind, Ortho, D, Patel, Jwalant, Khandge, Ashwin, Mewara, Navin
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container_title Spine (Philadelphia, Pa. 1976)
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creator Kulkarni, Arvind
Ortho, D
Patel, Jwalant
Khandge, Ashwin
Mewara, Navin
description STUDY DESIGN.Cohort. OBJECTIVE.To evaluate peri-operative morbidity in patients undergoing minimally invasive spine surgery (MISS) of the lumbar spine while continuing the anti-platelet drug (APD) peri-operatively as compared to those not continuing these drugs and those not on these drugs. SUMMARY OF BACKGROUND DATA.While discontinuation of anti-platelet drugs carries with it the risk of thrombosis of the cardiac stents, myocardial infarction, peripheral vascular occlusion, cerebro-vascular events and other thrombotic complications, continuation of these drugs has the risk of intra spinal bleeding and the serious consequences of subsequent epidural hematoma with associated spinal cord compression. METHODS.This institutional review board approved study included 1587 patients from 2011 to 2018. Peri-operative parameters were analyzed for 216 patients who underwent spinal surgery after the discontinuation of anticoagulation therapy, 240 patients who continued to take APD daily through the peri-operative period and 1131 patients who were never exposed to APD therapy. The operative time, intra-operative estimated blood loss, length of hospital stay, incidence of clinically evident hematoma and transfusion of blood products were also recorded and compared in 3 cohorts. RESULTS.The patients who continued taking APD in the peri-operative period had a longer length of hospital stay on average (2.5 ± 0.67 VS 1.59 ± 0.76 and 1.67 ± 0.83, P 
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OBJECTIVE.To evaluate peri-operative morbidity in patients undergoing minimally invasive spine surgery (MISS) of the lumbar spine while continuing the anti-platelet drug (APD) peri-operatively as compared to those not continuing these drugs and those not on these drugs. SUMMARY OF BACKGROUND DATA.While discontinuation of anti-platelet drugs carries with it the risk of thrombosis of the cardiac stents, myocardial infarction, peripheral vascular occlusion, cerebro-vascular events and other thrombotic complications, continuation of these drugs has the risk of intra spinal bleeding and the serious consequences of subsequent epidural hematoma with associated spinal cord compression. METHODS.This institutional review board approved study included 1587 patients from 2011 to 2018. Peri-operative parameters were analyzed for 216 patients who underwent spinal surgery after the discontinuation of anticoagulation therapy, 240 patients who continued to take APD daily through the peri-operative period and 1131 patients who were never exposed to APD therapy. The operative time, intra-operative estimated blood loss, length of hospital stay, incidence of clinically evident hematoma and transfusion of blood products were also recorded and compared in 3 cohorts. RESULTS.The patients who continued taking APD in the peri-operative period had a longer length of hospital stay on average (2.5 ± 0.67 VS 1.59 ± 0.76 and 1.67 ± 0.83, P &lt; 0.05), whereas there was no significant difference in the operative time, estimated blood loss, the amount of blood products transfused and overall intra and post-operative complication rate. There were no instances of post-operative wound soakage or neurological deficit suggestive of possible spinal epidural hematomas in either of the study groups. CONCLUSION.The current study has observed no appreciable increase in peri-operative morbidities including bleeding related complication rates in patients undergoing lumbar MISS while continuing to take APD compared with patients who either discontinued APD prior to surgery or those not taking APD.Level of Evidence4</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0000000000003357</identifier><language>eng</language><publisher>Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><ispartof>Spine (Philadelphia, Pa. 1976), 2019-12</ispartof><rights>Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids></links><search><creatorcontrib>Kulkarni, Arvind</creatorcontrib><creatorcontrib>Ortho, D</creatorcontrib><creatorcontrib>Patel, Jwalant</creatorcontrib><creatorcontrib>Khandge, Ashwin</creatorcontrib><creatorcontrib>Mewara, Navin</creatorcontrib><title>The Practice of Continuation of Anti Platelet Therapy During the Peri-Operative Period in Lumbar Minimally Invasive Spine Surgery (MISS): How Different is the Morbidity in This Scenario?</title><title>Spine (Philadelphia, Pa. 1976)</title><description>STUDY DESIGN.Cohort. OBJECTIVE.To evaluate peri-operative morbidity in patients undergoing minimally invasive spine surgery (MISS) of the lumbar spine while continuing the anti-platelet drug (APD) peri-operatively as compared to those not continuing these drugs and those not on these drugs. SUMMARY OF BACKGROUND DATA.While discontinuation of anti-platelet drugs carries with it the risk of thrombosis of the cardiac stents, myocardial infarction, peripheral vascular occlusion, cerebro-vascular events and other thrombotic complications, continuation of these drugs has the risk of intra spinal bleeding and the serious consequences of subsequent epidural hematoma with associated spinal cord compression. METHODS.This institutional review board approved study included 1587 patients from 2011 to 2018. Peri-operative parameters were analyzed for 216 patients who underwent spinal surgery after the discontinuation of anticoagulation therapy, 240 patients who continued to take APD daily through the peri-operative period and 1131 patients who were never exposed to APD therapy. The operative time, intra-operative estimated blood loss, length of hospital stay, incidence of clinically evident hematoma and transfusion of blood products were also recorded and compared in 3 cohorts. RESULTS.The patients who continued taking APD in the peri-operative period had a longer length of hospital stay on average (2.5 ± 0.67 VS 1.59 ± 0.76 and 1.67 ± 0.83, P &lt; 0.05), whereas there was no significant difference in the operative time, estimated blood loss, the amount of blood products transfused and overall intra and post-operative complication rate. There were no instances of post-operative wound soakage or neurological deficit suggestive of possible spinal epidural hematomas in either of the study groups. CONCLUSION.The current study has observed no appreciable increase in peri-operative morbidities including bleeding related complication rates in patients undergoing lumbar MISS while continuing to take APD compared with patients who either discontinued APD prior to surgery or those not taking APD.Level of Evidence4</description><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid/><recordid>eNqlUMtOwzAQtBBIlMcfcNgjHFLihKQtFwQtqJWIqEjukZtumgXXrhynUX6Nr8MBDogre9jVjGZmpWHsgvtD7k9G1w-v6dD_NWEYjQ7YgEfB2OM8mhyygR_GgRfchPExO6nrNyeKQz4ZsI-sQlgaUVgqEHQJU60sqUZY0qrH9w7CUgqLEi04tRG7DmaNIbUB25vRkPeyc7yl_TfUayAFz812JQwkpGgrpOxgofai7jXpjpTbjdmg6eAyWaTp1S3MdQszKks0qCxQ_ZWeaLOiNdmuT8wqx6YFKuF-3J2xo1LIGs9_7ikbPz1m07nXamnR1O-yadHkFQppq5z7ed9V7rrK_3YV_sP6CdRYdk0</recordid><startdate>20191205</startdate><enddate>20191205</enddate><creator>Kulkarni, Arvind</creator><creator>Ortho, D</creator><creator>Patel, Jwalant</creator><creator>Khandge, Ashwin</creator><creator>Mewara, Navin</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope/></search><sort><creationdate>20191205</creationdate><title>The Practice of Continuation of Anti Platelet Therapy During the Peri-Operative Period in Lumbar Minimally Invasive Spine Surgery (MISS): How Different is the Morbidity in This Scenario?</title><author>Kulkarni, Arvind ; Ortho, D ; Patel, Jwalant ; Khandge, Ashwin ; Mewara, Navin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-wolterskluwer_health_10_1097_BRS_00000000000033573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><toplevel>online_resources</toplevel><creatorcontrib>Kulkarni, Arvind</creatorcontrib><creatorcontrib>Ortho, D</creatorcontrib><creatorcontrib>Patel, Jwalant</creatorcontrib><creatorcontrib>Khandge, Ashwin</creatorcontrib><creatorcontrib>Mewara, Navin</creatorcontrib><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kulkarni, Arvind</au><au>Ortho, D</au><au>Patel, Jwalant</au><au>Khandge, Ashwin</au><au>Mewara, Navin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Practice of Continuation of Anti Platelet Therapy During the Peri-Operative Period in Lumbar Minimally Invasive Spine Surgery (MISS): How Different is the Morbidity in This Scenario?</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><date>2019-12-05</date><risdate>2019</risdate><issn>0362-2436</issn><eissn>1528-1159</eissn><abstract>STUDY DESIGN.Cohort. OBJECTIVE.To evaluate peri-operative morbidity in patients undergoing minimally invasive spine surgery (MISS) of the lumbar spine while continuing the anti-platelet drug (APD) peri-operatively as compared to those not continuing these drugs and those not on these drugs. SUMMARY OF BACKGROUND DATA.While discontinuation of anti-platelet drugs carries with it the risk of thrombosis of the cardiac stents, myocardial infarction, peripheral vascular occlusion, cerebro-vascular events and other thrombotic complications, continuation of these drugs has the risk of intra spinal bleeding and the serious consequences of subsequent epidural hematoma with associated spinal cord compression. METHODS.This institutional review board approved study included 1587 patients from 2011 to 2018. Peri-operative parameters were analyzed for 216 patients who underwent spinal surgery after the discontinuation of anticoagulation therapy, 240 patients who continued to take APD daily through the peri-operative period and 1131 patients who were never exposed to APD therapy. The operative time, intra-operative estimated blood loss, length of hospital stay, incidence of clinically evident hematoma and transfusion of blood products were also recorded and compared in 3 cohorts. RESULTS.The patients who continued taking APD in the peri-operative period had a longer length of hospital stay on average (2.5 ± 0.67 VS 1.59 ± 0.76 and 1.67 ± 0.83, P &lt; 0.05), whereas there was no significant difference in the operative time, estimated blood loss, the amount of blood products transfused and overall intra and post-operative complication rate. There were no instances of post-operative wound soakage or neurological deficit suggestive of possible spinal epidural hematomas in either of the study groups. CONCLUSION.The current study has observed no appreciable increase in peri-operative morbidities including bleeding related complication rates in patients undergoing lumbar MISS while continuing to take APD compared with patients who either discontinued APD prior to surgery or those not taking APD.Level of Evidence4</abstract><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><doi>10.1097/BRS.0000000000003357</doi></addata></record>
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title The Practice of Continuation of Anti Platelet Therapy During the Peri-Operative Period in Lumbar Minimally Invasive Spine Surgery (MISS): How Different is the Morbidity in This Scenario?
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