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Thrombophilic Abnormalities in Patients With or Without Pulmonary Embolism Following Elective Spinal Surgery

A Pilot Study

  • Original Article
  • Published:
HSS Journal ®

Abstract

Background

Significance of the thrombophilic abnormalities in development of venous thromboembolism (VTE) has been studies with total hip arthroplasty and acute traumatic spinal cord injury. However, their role as risk factors for VTE in elective spinal surgery remains to be determined.

Questions/Purposes

To determine the role of thrombophilic abnormalities in the development of pulmonary embolism (PE) following elective spine surgery.

Methods

Case and control groups were created in patients who had undergone elective spinal surgery for degenerative conditions. The PE group comprised 12 patients whose post-operative course was complicated by development of PE. The control group included 12 patients with an uneventful post-operative course. Demographic data including age, gender and surgical procedures were matched between the PE group and the control group. Both groups were evaluated for thrombophilic and hypofibrinolytic risk factors at 3 months post-operatively or later. Blood tests were performed to measure fasting serum homocysteine, antithrombin III, and protein C. Molecular genetic testing was conducted for detection of the plasminogen activator inhibitor-1 4G/4G, and prothrombin 3 UTR gene mutations.

Results

Heterozygous mutation (G20201A) of prothrombin was detected in two patients (16.7%) in the PE group, whereas no such mutation was noted in the control group. Plasminogen activator inhibitor-1 4G/4G homozygous mutation was seen in three in the PE group and two in the control group. Of homocysteine, antithrombin III and protein C, only one patient in each group showed abnormal levels of homocysteine. In total, there half of the patients in the PE group had at least one thrombophilic abnormality, whereas three (25%) patients showed such abnormality in the control group.

Conclusion

These findings suggest the involvement of thrombophilic abnormalities, especially the heterozygous G20201A mutation, in the development of PE in patients undergoing elective spinal surgery.

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Disclosures

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article. One or more of authors has or may receive payments or benefits from a commercial entity that may be perceived as a potential conflict of interest.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Suhel Kotwal MD, Alexander Hughes MD, Frank Cammisa Jr. MD, Kai Zhang MD, Eduardo Salvati MD & Federico Girardi MD

  2. Department of Orthopedic Surgery, Truman Medical Center, Hospital Hill, 2301 Holmes Street, Kansas City, MO, 64108, USA

    Suhel Kotwal MD

  3. Weill Cornell College of Medicine, New York, NY, 10065, USA

    Alexander Hughes MD, Frank Cammisa Jr. MD, Kai Zhang MD, Eduardo Salvati MD & Federico Girardi MD

  4. Department of Orthopaedic Surgery, Sapporo Medical University, South 1, West 16, Sapporo, 060-8543, Japan

    Satoshi Kawaguchi MD

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  1. Suhel Kotwal MD
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  2. Satoshi Kawaguchi MD
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  3. Alexander Hughes MD
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  4. Frank Cammisa Jr. MD
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  5. Kai Zhang MD
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  6. Eduardo Salvati MD
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  7. Federico Girardi MD
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Corresponding author

Correspondence to Suhel Kotwal MD.

Additional information

Level of evidence: Level III Prognostic Study.

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Kotwal, S., Kawaguchi, S., Hughes, A. et al. Thrombophilic Abnormalities in Patients With or Without Pulmonary Embolism Following Elective Spinal Surgery. HSS Jrnl 9, 32–35 (2013). https://doi.org/10.1007/s11420-012-9318-4

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  • DOI: https://doi.org/10.1007/s11420-012-9318-4

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