Incidence of Deep Venous Thrombosis and Sickle Cell Disease in Patients Undergoing Spinal Surgery in South Gujarat, India: A Prospective Observational Study

Overview

Journal Malays Orthop J

Specialty Orthopedics

Date 2022 Aug 22

PMID 35992978

Authors

H J Menon

A P Khanna

Y B Patel

Affiliations

Soon will be listed here.

Abstract

Introduction: Our objective of this study was to assess the incidence of Deep Venous Thrombosis in patients including those with sickle cell disease who underwent spine surgery, and also to determine the association of Sickle Cell Disease as a clinical predictor for Deep Venous Thrombosis in spinal surgery patients.

Materials And Methods: All patients who underwent spinal surgery from January 2016 to October 2016 were included in this study. Detailed history, demographic data, physical findings, pre-operative haematological and radiological investigations were documented. All the patients underwent daily clinical evaluation for clinical signs of Deep Venous Thrombosis and also underwent a post-operative venous Doppler and D-dimer test.

Results: Seventy-nine consecutive patients were included in the study with the mean age of 41 years. All patients had normal venous Doppler pre-operatively. A total of 2.5% patients had deep vein thrombosis in bilateral lower limbs while 2 patients (2.5%) had evidence of venous stasis but no thrombosis on Doppler ultrasound done post-operatively. Nine patients (11.4%) were sickle cell positive from which 4 patients showed evidence of Deep Venous Thrombosis or Venous Stasis. D-dimer was positive in 5 (8.3%) patients which included 4 patients with Sickle Cell Disease.

Conclusion: This study concludes that Sickle Cell Disease is a risk factor for developing Deep Venous Thrombosis in patients undergoing spinal surgery. The study also concludes the effectiveness of mechanical prophylaxis in preventing Deep Venous Thrombosis and recommends pharmacological prophylaxis after assessing the risk profile or positive D-dimer test.

References

Colah R, Mukherjee M, Martin S, Ghosh K . Sickle cell disease in tribal populations in India. Indian J Med Res. 2015; 141(5):509-15. PMC: 4510747. DOI: 10.4103/0971-5916.159492. View

Shabat S, Nyska A, LONG P, Goelman G, Abramovitch R, Ezov N . Osteonecrosis in a chemically induced rat model of human hemolytic disorders associated with thrombosis--a new model for avascular necrosis of bone. Calcif Tissue Int. 2003; 74(3):220-8. DOI: 10.1007/s00223-003-0068-7. View

Villagra J, Shiva S, Hunter L, Machado R, Gladwin M, Kato G . Platelet activation in patients with sickle disease, hemolysis-associated pulmonary hypertension, and nitric oxide scavenging by cell-free hemoglobin. Blood. 2007; 110(6):2166-72. PMC: 1976348. DOI: 10.1182/blood-2006-12-061697. View

Hamidi S, Riazi M . Cutoff values of plasma d-dimer level in patients with diagnosis of the venous thromboembolism after elective spinal surgery. Asian Spine J. 2015; 9(2):232-8. PMC: 4404538. DOI: 10.4184/asj.2015.9.2.232. View

Cho J, Kim J, Lee D . Correlation Between D-Dimer Level and Deep Venous Thrombosis in Patients With Acute Spinal Cord Injuries. Am J Phys Med Rehabil. 2020; 99(7):613-616. PMC: 7292501. DOI: 10.1097/PHM.0000000000001383. View

Al-Dujaili T, Majer C, Madhoun T, Kassis S, Saleh A . Deep venous thrombosis in spine surgery patients: incidence and hematoma formation. Int Surg. 2012; 97(2):150-4. PMC: 3723201. DOI: 10.9738/CC71.1. View

Nanclares B, Padilla-Zambrano H, El-Menyar A, Moscote-Salazar L, Galwankar S, Pal R . WACEM Consensus Paper on Deep Venous Thrombosis after Traumatic Spinal Cord Injury. J Emerg Trauma Shock. 2019; 12(2):150-154. PMC: 6557050. DOI: 10.4103/JETS.JETS_125_18. View

Holbrook A, Schulman S, Witt D, Vandvik P, Fish J, Kovacs M . Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e152S-e184S. PMC: 3278055. DOI: 10.1378/chest.11-2295. View

Caprini J, Arcelus J, Maksimovic D, Glase C, Sarayba J, Hathaway K . Thrombosis prophylaxis in orthopedic surgery: current clinical considerations. J South Orthop Assoc. 2003; 11(4):190-6. View

10.

Gould M, Garcia D, Wren S, Karanicolas P, Arcelus J, Heit J . Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e227S-e277S. PMC: 3278061. DOI: 10.1378/chest.11-2297. View

11.

Oda T, Fuji T, Kato Y, Fujita S, Kanemitsu N . Deep venous thrombosis after posterior spinal surgery. Spine (Phila Pa 1976). 2000; 25(22):2962-7. DOI: 10.1097/00007632-200011150-00019. View

12.

Ataga K, Moore C, Hillery C, Jones S, Whinna H, Strayhorn D . Coagulation activation and inflammation in sickle cell disease-associated pulmonary hypertension. Haematologica. 2008; 93(1):20-6. DOI: 10.3324/haematol.11763. View

13.

Naik R, Streiff M, Lanzkron S . Sickle cell disease and venous thromboembolism: what the anticoagulation expert needs to know. J Thromb Thrombolysis. 2013; 35(3):352-8. PMC: 4335704. DOI: 10.1007/s11239-013-0895-y. View

14.

. Prevention of venous thrombosis and pulmonary embolism. NIH Consensus Development. JAMA. 1986; 256(6):744-9. View

15.

Namboothiri S . Incidence of deep vein thrombosis after major spine surgeries with no mechanical or chemical prophylaxis. Evid Based Spine Care J. 2013; 3(3):29-33. PMC: 3592767. DOI: 10.1055/s-0032-1327807. View

16.

Adjepong K, Otegbeye F, Adjepong Y . Perioperative Management of Sickle Cell Disease. Mediterr J Hematol Infect Dis. 2018; 10(1):e2018032. PMC: 5937979. DOI: 10.4084/MJHID.2018.032. View

17.

Bono C, Watters 3rd W, Heggeness M, Resnick D, Shaffer W, Baisden J . An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery. Spine J. 2009; 9(12):1046-51. DOI: 10.1016/j.spinee.2009.09.005. View

18.

Kearon C, Akl E, Comerota A, Prandoni P, Bounameaux H, Goldhaber S . Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e419S-e496S. PMC: 3278049. DOI: 10.1378/chest.11-2301. View

19.

Cain Jr J, Major M, Lauerman W, West J, Wood K, Fueredi G . The morbidity of heparin therapy after development of pulmonary embolus in patients undergoing thoracolumbar or lumbar spinal fusion. Spine (Phila Pa 1976). 1995; 20(14):1600-3. DOI: 10.1097/00007632-199507150-00008. View

20.

Glotzbecker M, Bono C, Harris M, Brick G, Heary R, Wood K . Surgeon practices regarding postoperative thromboembolic prophylaxis after high-risk spinal surgery. Spine (Phila Pa 1976). 2008; 33(26):2915-21. DOI: 10.1097/BRS.0b013e318190702a. View