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  4. Is Blood Loss Greater in Elderly Patients under Antiplatelet or Anticoagulant Medication for Cervical Spine Injury Surgery? A Japanese Multicenter Survey

Is Blood Loss Greater in Elderly Patients under Antiplatelet or Anticoagulant Medication for Cervical Spine Injury Surgery? A Japanese Multicenter Survey

Spine Surg Relat Res, 2022 · DOI: 10.22603/ssrr.2021-0183 · Published: December 27, 2021

Spinal Cord InjuryAgingPharmacology

Simple Explanation

Elderly patients with cervical spinal cord injury often have other health issues, such as heart and brain blood vessel problems. They frequently take antiplatelet or anticoagulant medications. This study investigates whether these medications increase bleeding during surgery for cervical spine injuries in the elderly. This study reviewed the records of 1512 patients with cervical spine injuries at 33 hospitals. After excluding some cases, 797 patients were included. The study looked at how much blood was lost during surgery and whether patients were taking antiplatelet or anticoagulant medications. The study found that using antiplatelet or anticoagulant medications did not significantly increase blood loss during surgery in elderly patients with cervical spine injuries. Surgeons can focus on the patient's overall health and other medical conditions when deciding if surgery is right for them.

Study Duration
2010 to 2020
Participants
797 elderly patients with cervical spine injury
Evidence Level
Not specified

Key Findings

  • 1
    APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses.
  • 2
    There was no significant difference in the incidence of intraoperative complications between the groups (p =0.46).
  • 3
    Massive bleeding of more than 1000 mL was noted in 14 cases (2.3%) in the APAC−group and 5 cases (3.2%) in the APAC+ group, the incidence of which was comparable (p=0.56).

Research Summary

This multicenter study investigated whether antiplatelet/anticoagulant (APAC) drugs affect blood loss during surgery for cervical spine trauma in elderly patients. The study found no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs, suggesting comparable blood loss can be expected in APAC and non-APAC cases. Surgeons may prioritize patient background, complications, and preexisting conditions over APAC use when determining surgical indications for cervical spine trauma in the elderly.

Practical Implications

Surgical Planning

Surgeons can potentially plan cervical spine injury surgeries in elderly patients on APAC drugs with the expectation of blood loss comparable to those not on such medications.

Risk Assessment

The focus can shift towards a more holistic assessment of patient risk factors beyond just APAC medication use.

Clinical Decision-Making

The study supports a more nuanced approach to surgical indications, prioritizing patient-specific factors over concerns about increased blood loss due to APAC drugs.

Study Limitations

  • 1
    Retrospective case series with no control group.
  • 2
    Heterogeneous population due to bias of participating medical institutions.
  • 3
    Lack of follow-up data; APAC-related bleeding complications may have occurred outside of the observation period.

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