The prevalence of venous thromboembolism in patients with prophylactic low molecular weight heparin and/or mechanical measures after degenerative lumbar surgery: a systematic review and meta-analysis

作者：Li Jia Qi; Zhao Bing Yi; Kong Ling De; Gao Xian Da; Zhang Jing Tao; Shen Yong^*

来源：International Journal of Clinical and Experimental Medicine, 2017, 10(6): 8677-8690.

• Lumbar
• surgery
• low molecular weight heparin
• mechanical prophylaxis
• venous thromboembolism

Purpose: Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary embolism (PE). Consensus had yet to be reached on the prevention for thromboembolic events following degenerative spine surgery. Therefore, we wished to evaluate the efficacy and safety of mechanical measures as well as LMWH on prevention for VTE in patients after degenerative lumbar spinal surgery. Methods: We searched the PubMed, EMBASE, and the Cochrane library databases. A systematic review and meta-analysis were performed according to the following inclusive selection criteria: (a) population: patients with lumbar degenerative diseases. (b) intervention: postoperative VTE prophylaxis with LMWH and/or mechanical methods. We performed a subgroup analysis to explain heterogeneity. In addition, the Egger test and Egger graph were conducted to find publication bias with a P value < 0.05 being statistically significant. Results: Eleven studies met our inclusion criteria with a total of 6993 patients. The pooled prevalence of total DVT was 11.4% (8.7%, 14.5%) and that of distal DVT was 9.6% (7.1%, 12.4%). In contrast, the occurrence rates of symptomatic DVT [0.64% (0.49%, 0.81%)], proximal DVT [1.7% (0.8%, 2.7%)], total PE [1.00% (0.72%, 1.21%)] and symptomatic PE [0.9% (0.64%, 1.1%)] were low. One patient suffered from a postoperative PE was died. No postoperative hematoma was reported. Conclusion: We recommended mechanical prophylaxis for patients after degenerative lumbar open surgery. Routinely postoperative examination with Doppler ultrasound for these patients should be recommended. Further prospective and high-quality studies should be conducted to find a better anticoagulation regime balancing efficacy and safety.

• 出版日期2017
• 单位河北医科大学