Pharmacoprophylaxis for venous thromboembolism in spinal surgery: a systematic review and meta-analysis.

Objective Venous thromboembolism (VTE) is a significant contributor to postoperative morbidity and mortality. Prophylactic regimens for VTE involve mechanical prophylaxis as well as pharmacoprophylaxis. This systematic review and meta-analysis aimed to determine the efficacy and safety of pharmacoprophylaxis in comparison to any non-pharmacoprophylaxis regimen for the prevention of postoperative VTE in patients undergoing spinal surgery. Methods MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov , and ICRCTN were searched for comparative studies including both pharmacoprophylaxis and non-pharmacoprophylaxis post spinal surgery. The primary outcome was the incidence of VTE within the postoperative hospitalized period. The secondary outcomes included the incidence of spinal epidural hematoma, significant bleeding events, and other adverse events associated with VTE. The data was pooled using random-effects models of meta-analysis and relative risk (RR) was calculated. Results Four retrospective and three randomized controlled trials (RCTs) representing a total of 8373 patients were included. Overall, there was a significant decrease in postoperative Deep Venous Thrombosis (DVT) with pharmacoprophylaxis versus non-pharmacoprophylaxis (RR 0.42, 95% CI 0.21 to 0.86, P=0.02, I2=0%), however, there was no significant differences between the groups in the incidences of VTE (RR 0.31, 95% CI 0.12 to 0.81, P=0.02, I2=0%). The incidences of spinal epidural hematoma and significant bleeding events were rare and comparable in both groups. Conclusions This systematic review and meta-analysis found a potential benefit with pharmacoprophylaxis post spinal surgery in the prevention of DVT. However, there is a need for future RCTs to investigate the efficacy and safety of pharmacoprophylaxis in spinal surgery across various spinal procedures.