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Thromboseprophylaxe und Aggregationshemmer in der Wirbelsäulenchirurgie

Perioperative Management

Thromboprophylaxis and platelet aggregation inhibitors in spinal surgery

Perioperative management

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Zusammenfassung

Hintergrund

Die perioperative Gabe von Antikoagulanzien (AK) und Thrombozytenaggregationshemmern (TAH) in der Wirbelsäulenchirurgie (WSC) suggeriert eine erhöhte Rate epiduraler Blutungen, Daten dazu fehlen. Oft sind die Substanzen zur Verhinderung thromboembolischer Komplikationen unverzichtbar. Eine übergreifende Handlungsempfehlung zum Einsatz von AK und TAH fehlt.

Ziel der Arbeit

Ziel der Studie war eine Analyse der Ist-Situation (Einsatz von TAH und AK in der WSC) als Grundlage für Empfehlungen weiterer Studien und Leitlinienentwicklung.

Material und Methoden

Es erfolgten 2 unabhängige Umfragen an deutschen Wirbelsäulenzentren zur perioperativen Anwendung von AK und TAH und die Erfassung des perioperativen Einsatzes von AK und TAH, Risikoeinschätzung des thromboembolischen und Blutungsrisikos sowie zu Art und Umfang eingesetzter Substanzgruppen.

Ergebnisse

Trotz Risikoklassifikation wird eine Risikoadjustierung der Thromboembolieprophylaxe nicht vorgenommen, fast alle Patienten in der WSC erhalten perioperativ niedermolekulares Heparin (98 %), 64 % beginnen die medikamentöse Prophylaxe prä-, 36 % postoperativ. Die Dauer der medikamentösen Prophylaxe wird willkürlich festgelegt. Etwa 40 % der Befragten infiltrieren paravertebral, 19 % epidural unter TAH.

Bei Operationen mit Spinalkanaleröffnung werden bei bis zu 30 % TAH toleriert, ohne Eröffnung bei bis zu 40 %. Die Risikoabschätzung der THA unterscheidet deutlich zwischen ASS und Rezeptorblockern sowie dualer TAH-Gabe.

Diskussion

Der Umgang mit AK und TAH in der WSC in Deutschland ist sehr heterogen, teilweise wird deutlich von Leitlinien abgewichen. Es lässt sich klar Bedarf für Studien erkennen, die Zahlen zur konkreten Risikobewertung der perioperativen AK- und TAH-Gabe liefern, um konkrete Handlungsempfehlungen abgeben zu können.

Abstract

Background

The perioperative use of anticoagulants (AC) and platelet aggregation inhibitors (PAI) in the field of spinal surgery suggests an increased rate of epidural bleeding. However, evidence is lacking and these medications are most often indispensable in the prevention of thromboembolic complications. Comprehensive recommendations for the correct use of AC and PAI are lacking.

Objective

The aim of this study was an analysis of the current situation with regards to the use of AC and PAI in spinal surgery and development of new recommendations.

Material and methods

Two independent surveys on the perioperative use of AC and PAI were obtained from centers for spinal surgery in Germany. The study obtained information on the perioperative use of AC and PAI, risk assessment of thromboembolic and hemorrhagic events as well as on the type and extent of the substance groups used.

Results

Almost the entire patient collective (98 %) received perioperative low molecular weight heparin. In 64 % the medical prophylaxis was started before surgery and in 36 % after surgery. The period of prophylaxis was determined arbitrarily. Approximately 40 % of interviewees employed paravertebral infiltration and 19 % injected into the epidural space in patients on PAI medication. Open spinal canal surgery was performed in 30 % of PAI medicated patients and closed spinal canal surgery was executed in 40 %. The risk assessment of PAI differed significantly between aspirin and receptor blocker medication as well as dual administration of PAI.

Discussion

The use of AC and PAI in spinal surgery in Germany is very heterogeneous and large deviations from the guidelines frequently occurred. Therefore, there is a strong need for further studies to accurately assess the perioperative use of AC and PAI and to formulate precise recommendations.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M Quante, R. Zamani, M.J.K. Simon, J. Klasen, V. Bullmann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Wirbelsäulenchirurgie, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Deutschland

    M. Quante

  2. Orthopädische Wirbelsäulenchirurgie, Hamburg, Deutschland

    R. Zamani

  3. Institut für Osteologie und Biomechanik, Lehrstuhl für Osteologie, Universität Hamburg, Hamburg, Deutschland

    M.J.K. Simon

  4. Zentralklinikum, Universitätsklinikum Münster, Münster, Deutschland

    J. Klasen

  5. Klinik für Wirbelsäulenchirurgie, St.-Franziskus-Hospital, Köln, Deutschland

    V. Bullmann

Authors
  1. M. Quante
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  2. R. Zamani
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  3. M.J.K. Simon
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  4. J. Klasen
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  5. V. Bullmann
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Correspondence to M. Quante.

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Quante, M., Zamani, R., Simon, M. et al. Thromboseprophylaxe und Aggregationshemmer in der Wirbelsäulenchirurgie. Orthopäde 43, 833–840 (2014). https://doi.org/10.1007/s00132-014-2319-x

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  • DOI: https://doi.org/10.1007/s00132-014-2319-x

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