PMID- 34634115
OWN - NLM
STAT- MEDLINE
DCOM- 20220323
LR  - 20220323
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
VI  - 89
IP  - 6
DP  - 2021 Nov 18
TI  - Prophylactic Low-Molecular-Weight Heparin Versus Unfractionated Heparin in Spine 
      Surgery (PLUSS): A Pilot Matched Cohort Study.
PG  - 1097-1103
LID - 10.1093/neuros/nyab363 [doi]
AB  - BACKGROUND: Despite a proven superior efficacy of prophylactic 
      low-molecular-weight heparin (LMWH) over unfractionated heparin (UFH) in the 
      majority of surgical specialties, chemoprophylactic techniques after spine 
      surgery have not been established because of the fear of epidural hematomas with 
      LMWH. OBJECTIVE: To determine the efficacy of LMWH vs UFH in the prevention of 
      venous thromboembolism (VTE) events, balanced against the risk of epidural 
      hematoma. METHODS: This is the first matched cohort design that directly compares 
      prophylactic LMWH to UFH after spine surgery for degenerative/deformity 
      pathologies at a tertiary academic center. Prospectively collected patients 
      receiving prophylactic LMWH and a historical cohort of patients receiving 
      prophylactic UFH (prior to 2017) were matched in 1:1 ratio based on age +/-5 yr, 
      American Society of Anesthesiologists classification, location in the spinal 
      column, and type of surgery. RESULTS: Of 562 patients, VTE events equaled 1.4% 
      (n = 8): 1.4% (n = 4) with LMWH was exactly equal to 1.4% (n = 4) with UFH. 
      Epidural hematomas reached 0.8% (n = 5): 1.4% (n = 4) with UFH vs 0.3% (n = 1) 
      with the LMWH (P = .178). Utilizing adjusted odds ratio (ORadj), the type of 
      chemoprophylaxis after spine surgery failed to predict VTE events. Similarly, the 
      chemoprophylactic technique failed to predict epidural hematoma in the 
      multivariable regression analysis, although UFH trended toward a higher 
      complication rate (ORadj = 3.15 [0.48-20.35], P = .227). CONCLUSION: 
      Chemoprophylactic patterns failed to predict VTE. Although no differences in 
      epidural hematoma rates were detected, our analysis does highlight a trend toward 
      a safer profile with LMWH vs UFH. LMWH may be a safe alternative to UFH in spine 
      surgery.
CI  - (c) Congress of Neurological Surgeons 2021.
FAU - Macki, Mohamed
AU  - Macki M
AD  - Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
FAU - Haddad, Yazeed
AU  - Haddad Y
AD  - Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
FAU - Suryadevara, Raviteja
AU  - Suryadevara R
AD  - Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
FAU - Dabaja, Abed Latif
AU  - Dabaja AL
AD  - Department of Internal Medicine, Garden City Hospital, Garden City, Michigan, 
      USA.
FAU - Chedid, Mokbel
AU  - Chedid M
AD  - Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
FAU - Chang, Victor
AU  - Chang V
AUID- ORCID: 0000-0002-8580-0706
AD  - Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
CN  - PLUSS Investigators
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Neurosurgery. 2022 Jan 1;90(1):e13-e14. PMID: 34982888
MH  - Anticoagulants/therapeutic use
MH  - Child, Preschool
MH  - Cohort Studies
MH  - Heparin/therapeutic use
MH  - *Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - *Venous Thromboembolism/etiology/prevention & control
OTO - NOTNLM
OT  - Chemoprophylaxis
OT  - Heparin
OT  - Prophylactic low-molecular-weight heparin
OT  - Spine surgery
OT  - Unfractionated heparin
EDAT- 2021/10/12 06:00
MHDA- 2022/03/24 06:00
CRDT- 2021/10/11 17:21
PHST- 2021/06/02 00:00 [received]
PHST- 2021/08/04 00:00 [accepted]
PHST- 2021/10/12 06:00 [pubmed]
PHST- 2022/03/24 06:00 [medline]
PHST- 2021/10/11 17:21 [entrez]
AID - 6389658 [pii]
AID - 10.1093/neuros/nyab363 [doi]
PST - ppublish
SO  - Neurosurgery. 2021 Nov 18;89(6):1097-1103. doi: 10.1093/neuros/nyab363.