Skip to main content
SpringerLink
Log in

Antithrombotic Management in Spine Surgery in the Elderly

  • Chapter
  • First Online:
Treatment of Spine Disease in the Elderly

Abstract

Antithrombotic agents are commonly encountered among the elderly spine surgery patient population. Therefore, management of these medications is a key consideration for spine surgeons when preparing for surgery. Continuing antithrombotic therapy through the perioperative period increases the risk of perioperative bleeding. At the same time, stopping antithrombotic therapy prior to surgery increases the risk of perioperative thrombotic risk. This chapter reviews suggested guidelines for perioperative antithrombotic management for elective spine procedures, antithrombotic management for emergent procedures, and special considerations for antithrombotic management in the elderly.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bracey AW. Perioperative management of antithrombotic and antiplatelet therapy. Tex Heart Inst J. 2015;42(3):239–42. https://doi.org/10.14503/THIJ-15-5066.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Cheng JS, Arnold PM, Anderson PA, Fischer D, Dettori JR. Anticoagulation risk in spine surgery. Spine. 2010;35(9 Suppl):S117–24. https://doi.org/10.1097/BRS.0b013e3181d833d4.

    Article  PubMed  Google Scholar 

  3. Douketis JD, Bakhsh E. Perioperative management of antithrombotic therapy. Pol Arch Med Wewn. 2008;118(4):201–8.

    PubMed  Google Scholar 

  4. Kepler CK, McKenzie J, Kreitz T, Vaccaro A. Venous thromboembolism prophylaxis in spine surgery. J Am Acad Orthop Surg. 2018;26(14):489–500. https://doi.org/10.5435/JAAOS-D-17-00561.

    Article  PubMed  Google Scholar 

  5. Porto GBF, Jeffrey Wessell DO, Alvarado A, Arnold PM, Buchholz AL. Anticoagulation and Spine Surgery. Glob Spine J. 2020;10(1 Suppl):53S–64S. https://doi.org/10.1177/2192568219852051.

    Article  Google Scholar 

  6. Rockson HB, DiPaola CP, Connolly PJ, Stauff MP. Venous thromboembolism prophylaxis for patients having elective spine surgery: when, why, and how much. J Bone Joint Surg Am. 2019;101(13):1220–9. https://doi.org/10.2106/JBJS.18.00849.

    Article  PubMed  Google Scholar 

  7. Solaru S, Alluri RK, Wang JC, Hah RJ. Venous thromboembolism prophylaxis in elective spine surgery. Glob Spine J. 2021;11:1148. https://doi.org/10.1177/2192568220962439.

    Article  Google Scholar 

  8. Takahashi H, Yokoyama Y, Iida Y, Terashima F, Hasegawa K, Saito T, et al. Incidence of venous thromboembolism after spine surgery. J Orthop Sci. 2012;17(2):114–7. https://doi.org/10.1007/s00776-011-0188-2.

    Article  PubMed  Google Scholar 

  9. Wang T, Yang SD, Huang WZ, Liu FY, Wang H, Ding WY. Factors predicting venous thromboembolism after spine surgery. Medicine. 2016;95(52):e5776. https://doi.org/10.1097/MD.0000000000005776.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cox JB, Weaver KJ, Neal DW, Jacob RP, Hoh DJ. Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis: clinical article. J Neurosurg Spine. 2014;21(4):677–84. https://doi.org/10.3171/2014.6.SPINE13447.

    Article  PubMed  Google Scholar 

  11. Catre MG. Anticoagulation in spinal surgery. A critical review of the literature. Can J Surg. 1997;40(6):413–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Ferree BA. Deep venous thrombosis following lumbar laminotomy and laminectomy. Orthopedics. 1994;17(1):35–8.

    Article  CAS  PubMed  Google Scholar 

  13. Ferree BA, Stern PJ, Jolson RS, Roberts JM, Kahn A III. Deep venous thrombosis after spinal surgery. Spine. 1993;18(3):315–9. https://doi.org/10.1097/00007632-199303000-00001.

    Article  CAS  PubMed  Google Scholar 

  14. Oda T, Fuji T, Kato Y, Fujita S, Kanemitsu N. Deep venous thrombosis after posterior spinal surgery. Spine. 2000;25(22):2962–7. https://doi.org/10.1097/00007632-200011150-00019.

    Article  CAS  PubMed  Google Scholar 

  15. Rokito SE, Schwartz MC, Neuwirth MG. Deep vein thrombosis after major reconstructive spinal surgery. Spine. 1996;21(7):853–8. https://doi.org/10.1097/00007632-199604010-00016; discussion 9.

    Article  CAS  PubMed  Google Scholar 

  16. Paneni F, Diaz Canestro C, Libby P, Luscher TF, Camici GG. The aging cardiovascular system: understanding it at the cellular and clinical levels. J Am Coll Cardiol. 2017;69(15):1952–67. https://doi.org/10.1016/j.jacc.2017.01.064.

    Article  PubMed  Google Scholar 

  17. North BJ, Sinclair DA. The intersection between aging and cardiovascular disease. Circ Res. 2012;110(8):1097–108. https://doi.org/10.1161/CIRCRESAHA.111.246876.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Rosendaal FR. Venous thrombosis: prevalence and interaction of risk factors. Haemostasis. 1999;29(Suppl S1):1–9. https://doi.org/10.1159/000054106.

    Article  CAS  PubMed  Google Scholar 

  19. Kovacic JC, Moreno P, Nabel EG, Hachinski V, Fuster V. Cellular senescence, vascular disease, and aging: part 2 of a 2-part review: clinical vascular disease in the elderly. Circulation. 2011;123(17):1900–10. https://doi.org/10.1161/CIRCULATIONAHA.110.009118.

    Article  PubMed  Google Scholar 

  20. Bochenek ML, Schutz E, Schafer K. Endothelial cell senescence and thrombosis: ageing clots. Thromb Res. 2016;147:36–45. https://doi.org/10.1016/j.thromres.2016.09.019.

    Article  CAS  PubMed  Google Scholar 

  21. Dominguez LJ, Galioto A, Ferlisi A, Pineo A, Putignano E, Belvedere M, et al. Ageing, lifestyle modifications, and cardiovascular disease in developing countries. J Nutr Health Aging. 2006;10(2):143–9.

    CAS  PubMed  Google Scholar 

  22. Engbers MJ, van Hylckama VA, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost. 2010;8(10):2105–12. https://doi.org/10.1111/j.1538-7836.2010.03986.x.

    Article  CAS  PubMed  Google Scholar 

  23. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e326S–e50S. https://doi.org/10.1378/chest.11-2298.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation. 2014;129(8):837–47. https://doi.org/10.1161/CIRCULATIONAHA.113.005119.

    Article  PubMed  Google Scholar 

  25. Kornej J, Borschel CS, Benjamin EJ, Schnabel RB. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circ Res. 2020;127(1):4–20. https://doi.org/10.1161/CIRCRESAHA.120.316340.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933–44. https://doi.org/10.1161/CIR.0b013e31820a55f5.

    Article  PubMed  Google Scholar 

  27. Lutsey PL, Norby FL, Alonso A, Cushman M, Chen LY, Michos ED, et al. Atrial fibrillation and venous thromboembolism: evidence of bidirectionality in the Atherosclerosis Risk in Communities Study. J Thromb Haemost. 2018;16(4):670–9. https://doi.org/10.1111/jth.13974.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8. https://doi.org/10.1161/01.str.22.8.983.

    Article  CAS  PubMed  Google Scholar 

  29. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146(12):857–67. https://doi.org/10.7326/0003-4819-146-12-200706190-00007.

    Article  PubMed  Google Scholar 

  30. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955–62. https://doi.org/10.1016/S0140-6736(13)62343-0.

    Article  CAS  PubMed  Google Scholar 

  31. Fuentes AV, Pineda MD, Venkata KCN. Comprehension of top 200 prescribed drugs in the US as a resource for pharmacy teaching, training and practice. Pharmacy. 2018;6(2):43. https://doi.org/10.3390/pharmacy6020043.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Oprea AD, Popescu WM. Perioperative management of antiplatelet therapy. Br J Anaesth. 2013;111(Suppl 1):i3–17. https://doi.org/10.1093/bja/aet402.

    Article  PubMed  Google Scholar 

  33. Peters AT, Mutharasan RK. Aspirin for prevention of cardiovascular disease. JAMA. 2020;323(7):676. https://doi.org/10.1001/jama.2019.18425.

    Article  PubMed  Google Scholar 

  34. O’Brien CW, Juraschek SP, Wee CC. Prevalence of aspirin use for primary prevention of cardiovascular disease in the united states: results from the 2017 national health interview survey. Ann Intern Med. 2019;171(8):596–8. https://doi.org/10.7326/M19-0953.

    Article  PubMed  PubMed Central  Google Scholar 

  35. McNeil JJ, Woods RL, Nelson MR, Reid CM, Kirpach B, Wolfe R, et al. Effect of aspirin on disability-free survival in the healthy elderly. N Engl J Med. 2018;379(16):1499–508. https://doi.org/10.1056/NEJMoa1800722.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. McNeil JJ, Wolfe R, Woods RL, Tonkin AM, Donnan GA, Nelson MR, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379(16):1509–18. https://doi.org/10.1056/NEJMoa1805819.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Shufelt CL, Manson JE. Aspirin for primary prevention of cardiovascular disease in women. Menopause. 2020;27(5):605–6. https://doi.org/10.1097/GME.0000000000001547.

    Article  PubMed  Google Scholar 

  38. Yazdanyar A, Newman AB. The burden of cardiovascular disease in the elderly: morbidity, mortality, and costs. Clin Geriatr Med. 2009;25(4):563–77, vii. https://doi.org/10.1016/j.cger.2009.07.007.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Epstein NE. When to stop anticoagulation, anti-platelet aggregates, and non-steroidal anti-inflammatories (NSAIDs) prior to spine surgery. Surg Neurol Int. 2019;10:45. https://doi.org/10.25259/SNI-54-2019.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Douketis JD, Darvish-Kazem S, Spencer N, Tafur A. Perioperative management of patients who are receiving antiplatelet therapy: a case-based, evidence-informed approach. Pol Arch Intern Med. 2018;128(12):771–8. https://doi.org/10.20452/pamw.4403.

    Article  PubMed  Google Scholar 

  41. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation 2016;134(10):e123–55. https://doi.org/10.1161/CIR.0000000000000404.

  42. Secco GG, Parisi R, Mirabella F, Fattori R, Genoni G, Agostoni P, et al. P2Y12 inhibitors: pharmacologic mechanism and clinical relevance. Cardiovasc Hematol Agents Med Chem. 2013;11(2):101–5. https://doi.org/10.2174/1871525711311020005.

    Article  CAS  PubMed  Google Scholar 

  43. Damman P, Woudstra P, Kuijt WJ, de Winter RJ, James SK. P2Y12 platelet inhibition in clinical practice. J Thromb Thrombolysis. 2012;33(2):143–53. https://doi.org/10.1007/s11239-011-0667-5.

    Article  CAS  PubMed  Google Scholar 

  44. Diener HC, Cunha L, Forbes C, Sivenius J, Smets P, Lowenthal A. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996;143(1–2):1–13. https://doi.org/10.1016/s0022-510x(96)00308-5.

    Article  CAS  PubMed  Google Scholar 

  45. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, Jr. et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2019;74(1):104–32. https://doi.org/10.1016/j.jacc.2019.01.011.

  46. Scotti P, Seguin C, Lo BWY, de Guise E, Troquet JM, Marcoux J. Antithrombotic agents and traumatic brain injury in the elderly population: hemorrhage patterns and outcomes. J Neurosurg. 2019;133:486–95. https://doi.org/10.3171/2019.4.JNS19252.

    Article  Google Scholar 

  47. Xian Y, Xu H, O’Brien EC, Shah S, Thomas L, Pencina MJ, et al. Clinical effectiveness of direct oral anticoagulants vs warfarin in older patients with atrial fibrillation and ischemic stroke: findings from the patient-centered research into outcomes stroke patients prefer and effectiveness research (PROSPER) study. JAMA Neurol. 2019;76:1192. https://doi.org/10.1001/jamaneurol.2019.2099.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Shaw JR, Woodfine JD, Douketis J, Schulman S, Carrier M. Perioperative interruption of direct oral anticoagulants in patients with atrial fibrillation: a systematic review and meta-analysis. Res Pract Thromb Haemost. 2018;2(2):282–90. https://doi.org/10.1002/rth2.12076.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Tafur A, Douketis J. Perioperative management of anticoagulant and antiplatelet therapy. Heart. 2018;104(17):1461–7. https://doi.org/10.1136/heartjnl-2016-310581.

    Article  PubMed  Google Scholar 

  50. Murphy D, McCulloch CE, Lin F, Banerjee T, Bragg-Gresham JL, Eberhardt MS, et al. Trends in prevalence of chronic kidney disease in the United States. Ann Intern Med. 2016;165(7):473–81. https://doi.org/10.7326/M16-0273.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine evidence-based guidelines (Fourth Edition). Reg Anesth Pain Med. 2018;43(3):263–309. https://doi.org/10.1097/AAP.0000000000000763.

    Article  PubMed  Google Scholar 

  52. Narouze S, Benzon HT, Provenzano D, Buvanendran A, De Andres J, Deer T et al. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med 2018;43(3):225–62. https://doi.org/10.1097/AAP.0000000000000700.

  53. Bauer KA. Fondaparinux: basic properties and efficacy and safety in venous thromboembolism prophylaxis. Am J Orthop. 2002;31(11 Suppl):4–10.

    PubMed  Google Scholar 

  54. Baumgartner C, de Kouchkovsky I, Whitaker E, Fang MC. Periprocedural bridging in patients with venous thromboembolism: a systematic review. Am J Med. 2019;132(6):722–32.e7. https://doi.org/10.1016/j.amjmed.2019.01.004.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Siegal D, Yudin J, Kaatz S, Douketis JD, Lim W, Spyropoulos AC. Periprocedural heparin bridging in patients receiving vitamin K antagonists: systematic review and meta-analysis of bleeding and thromboembolic rates. Circulation. 2012;126(13):1630–9. https://doi.org/10.1161/CIRCULATIONAHA.112.105221.

    Article  CAS  PubMed  Google Scholar 

  56. Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373(9):823–33. https://doi.org/10.1056/NEJMoa1501035.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I9–16. https://doi.org/10.1161/01.CIR.0000078469.07362.E6.

    Article  PubMed  Google Scholar 

  58. Kulkarni SS, Lowery GL, Ross RE, Ravi Sankar K, Lykomitros V. Arterial complications following anterior lumbar interbody fusion: report of eight cases. Eur Spine J. 2003;12(1):48–54. https://doi.org/10.1007/s00586-002-0460-4.

    Article  PubMed  Google Scholar 

  59. Sim EM, Claydon MH, Parker RM, Malham GM. Brief intraoperative heparinization and blood loss in anterior lumbar spine surgery. J Neurosurg Spine. 2015;23(3):309–13. https://doi.org/10.3171/2014.12.SPINE14888.

    Article  PubMed  Google Scholar 

  60. Inamasu J, Guiot BH. Vascular injury and complication in neurosurgical spine surgery. Acta Neurochir. 2006;148(4):375–87. https://doi.org/10.1007/s00701-005-0669-1.

    Article  CAS  PubMed  Google Scholar 

  61. Chen CM, Ashjian P, Disa JJ, Cordeiro PG, Pusic AL, Mehrara BJ. Is the use of intraoperative heparin safe? Plast Reconstr Surg. 2008;121(3):49e–53e. https://doi.org/10.1097/01.prs.0000299267.84139.2a.

    Article  CAS  PubMed  Google Scholar 

  62. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):381S–453S. https://doi.org/10.1378/chest.08-0656.

    Article  CAS  PubMed  Google Scholar 

  63. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. 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–e77S. https://doi.org/10.1378/chest.11-2297.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. 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–e96S. https://doi.org/10.1378/chest.11-2301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Bono CM, Watters WC III, Heggeness MH, Resnick DK, Shaffer WO, Baisden J, et al. An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery. Spine J. 2009;9(12):1046–51. https://doi.org/10.1016/j.spinee.2009.09.005.

    Article  PubMed  Google Scholar 

  66. Agarwal N, Zenonos GA, Agarwal P, Walch FJ, Roach E, Stokes SJ, et al. Risk-to-benefit ratio of venous thromboembolism prophylaxis for neurosurgical procedures at a quaternary referral center. Neurosurgery. 2019;84(2):355–61. https://doi.org/10.1093/neuros/nyy035.

    Article  PubMed  Google Scholar 

  67. Lieber BA, Han J, Appelboom G, Taylor BE, Han B, Agarwal N, et al. Association of steroid use with deep venous thrombosis and pulmonary embolism in neurosurgical patients: a national database analysis. World Neurosurg. 2016;89:126–32. https://doi.org/10.1016/j.wneu.2016.01.033.

    Article  PubMed  Google Scholar 

  68. Gibbs NM. Venous thrombosis of the lower limbs with particular reference to bed-rest. Br J Surg. 1957;45(191):209–36. https://doi.org/10.1002/bjs.18004519102.

    Article  CAS  PubMed  Google Scholar 

  69. Fineberg SJ, Nandyala SV, Marquez-Lara A, Oglesby M, Patel AA, Singh K. Incidence and risk factors for postoperative delirium after lumbar spine surgery. Spine. 2013;38(20):1790–6. https://doi.org/10.1097/BRS.0b013e3182a0d507.

    Article  PubMed  Google Scholar 

  70. Kobayashi K, Ando K, Kato F, Kanemura T, Sato K, Hachiya Y, et al. Predictors of prolonged length of stay after lumbar interbody fusion: a multicenter study. Glob Spine J. 2019;9(5):466–72. https://doi.org/10.1177/2192568218800054.

    Article  Google Scholar 

  71. Devereaux PJ, Mrkobrada M, Sessler DI, Leslie K, Alonso-Coello P, Kurz A, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370(16):1494–503. https://doi.org/10.1056/NEJMoa1401105.

    Article  CAS  PubMed  Google Scholar 

  72. Graham MM, Sessler DI, Parlow JL, Biccard BM, Guyatt G, Leslie K, et al. Aspirin in patients with previous percutaneous coronary intervention undergoing noncardiac surgery. Ann Intern Med. 2018;168(4):237–44. https://doi.org/10.7326/M17-2341.

    Article  PubMed  Google Scholar 

  73. Mehta SR, Bainey KR, Cantor WJ, Lordkipanidze M, Marquis-Gravel G, Robinson SD, et al. 2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology focused update of the guidelines for the use of antiplatelet therapy. Can J Cardiol. 2018;34(3):214–33. https://doi.org/10.1016/j.cjca.2017.12.012.

    Article  PubMed  Google Scholar 

  74. Douketis JD, Spyropoulos AC, Duncan J, Carrier M, Le Gal G, Tafur AJ, et al. Perioperative management of patients with atrial fibrillation receiving a direct oral anticoagulant. JAMA Intern Med. 2019;179:1469. https://doi.org/10.1001/jamainternmed.2019.2431.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Strom RG, Frempong-Boadu AK. Low-molecular-weight heparin prophylaxis 24 to 36 hours after degenerative spine surgery: risk of hemorrhage and venous thromboembolism. Spine. 2013;38(23):E1498–502. https://doi.org/10.1097/BRS.0b013e3182a4408d.

    Article  PubMed  Google Scholar 

  76. Campbell PG, Sen A, Yadla S, Jabbour P, Jallo J. Emergency reversal of antiplatelet agents in patients presenting with an intracranial hemorrhage: a clinical review. World Neurosurg. 2010;74(2–3):279–85. https://doi.org/10.1016/j.wneu.2010.05.030.

    Article  PubMed  Google Scholar 

  77. Levy JH, Douketis J, Weitz JI. Reversal agents for non-vitamin K antagonist oral anticoagulants. Nat Rev Cardiol. 2018;15(5):273–81. https://doi.org/10.1038/nrcardio.2017.223.

    Article  CAS  PubMed  Google Scholar 

  78. Angelo M, Gutmann B, Adami M, Zagler B, Zelger A, Pechlaner C, et al. Emergency correction of coagulation before major surgery in two elderly patients on oral anticoagulation. Thromb J. 2007;5:1. https://doi.org/10.1186/1477-9560-5-1.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Levy JH, Douketis J, Steiner T, Goldstein JN, Milling TJ. Prothrombin complex concentrates for perioperative vitamin K antagonist and non-vitamin K anticoagulant reversal. Anesthesiology. 2018;129(6):1171–84. https://doi.org/10.1097/ALN.0000000000002399.

    Article  CAS  PubMed  Google Scholar 

  80. Thomas S, Makris M. The reversal of anticoagulation in clinical practice. Clin Med. 2018;18(4):314–9. https://doi.org/10.7861/clinmedicine.18-4-314.

    Article  Google Scholar 

  81. Agarwal P, Abdullah KG, Ramayya AG, Nayak NR, Lucas TH. A Retrospective propensity score-matched early thromboembolic event analysis of prothrombin complex concentrate vs fresh frozen plasma for warfarin reversal prior to emergency neurosurgical procedures. Neurosurgery. 2018;82(6):877–86. https://doi.org/10.1093/neuros/nyx327.

    Article  PubMed  Google Scholar 

  82. Pollack CV Jr, Reilly PA, Eikelboom J, Glund S, Verhamme P, Bernstein RA, et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015;373(6):511–20. https://doi.org/10.1056/NEJMoa1502000.

    Article  CAS  PubMed  Google Scholar 

  83. Ocak G, Rookmaaker MB, Algra A, de Borst GJ, Doevendans PA, Kappelle LJ, et al. Chronic kidney disease and bleeding risk in patients at high cardiovascular risk: a cohort study. J Thromb Haemost. 2018;16(1):65–73. https://doi.org/10.1111/jth.13904.

    Article  CAS  PubMed  Google Scholar 

  84. Molnar AO, Bota SE, Garg AX, Harel Z, Lam N, McArthur E, et al. The risk of major hemorrhage with CKD. J Am Soc Nephrol. 2016;27(9):2825–32. https://doi.org/10.1681/ASN.2015050535.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Eikelboom JW, van Ryn J, Reilly P, Hylek EM, Elsaesser A, Glund S, et al. Dabigatran reversal with idarucizumab in patients with renal impairment. J Am Coll Cardiol. 2019;74(14):1760–8. https://doi.org/10.1016/j.jacc.2019.07.070.

    Article  CAS  PubMed  Google Scholar 

  86. Connolly SJ, Crowther M, Eikelboom JW, Gibson CM, Curnutte JT, Lawrence JH, et al. Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors. N Engl J Med. 2019;380(14):1326–35. https://doi.org/10.1056/NEJMoa1814051.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Eerenberg ES, Kamphuisen PW, Sijpkens MK, Meijers JC, Buller HR, Levi M. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: a randomized, placebo-controlled, crossover study in healthy subjects. Circulation. 2011;124(14):1573–9. https://doi.org/10.1161/CIRCULATIONAHA.111.029017.

    Article  CAS  PubMed  Google Scholar 

  88. Raval AN, Cigarroa JE, Chung MK, Diaz-Sandoval LJ, Diercks D, Piccini JP, et al. Management of patients on non-vitamin k antagonist oral anticoagulants in the acute care and periprocedural setting: a scientific statement from the American Heart Association. Circulation. 2017;135(10):e604–e33. https://doi.org/10.1161/CIR.0000000000000477.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Beynon C, Potzy A, Unterberg AW, Sakowitz OW. Emergency neurosurgical care in patients treated with apixaban: report of 2 cases. Am J Emerg Med. 2015;33(6):858.e5–7. https://doi.org/10.1016/j.ajem.2014.12.017.

    Article  PubMed  Google Scholar 

  90. Bauersachs RM, Herold J. Oral anticoagulation in the elderly and frail. Hamostaseologie. 2020;40(1):74–83. https://doi.org/10.1055/s-0040-1701476.

    Article  PubMed  Google Scholar 

  91. Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6–14. https://doi.org/10.1046/j.1365-2125.2003.02007.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Kekki M, Samloff IM, Ihamaki T, Varis K, Siurala M. Age- and sex-related behaviour of gastric acid secretion at the population level. Scand J Gastroenterol. 1982;17(6):737–43. https://doi.org/10.3109/00365528209181087.

    Article  CAS  PubMed  Google Scholar 

  93. Corazza GR, Frazzoni M, Gatto MR, Gasbarrini G. Ageing and small-bowel mucosa: a morphometric study. Gerontology. 1986;32(1):60–5. https://doi.org/10.1159/000212766.

    Article  CAS  PubMed  Google Scholar 

  94. Crooks J, O’Malley K, Stevenson IH. Pharmacokinetics in the elderly. Clin Pharmacokinet. 1976;1(4):280–96. https://doi.org/10.2165/00003088-197601040-00003.

    Article  CAS  PubMed  Google Scholar 

  95. Benet LZ, Hoener BA. Changes in plasma protein binding have little clinical relevance. Clin Pharmacol Ther. 2002;71(3):115–21. https://doi.org/10.1067/mcp.2002.121829.

    Article  CAS  PubMed  Google Scholar 

  96. Qamar A, Vaduganathan M, Greenberger NJ, Giugliano RP. Oral anticoagulation in patients with liver disease. J Am Coll Cardiol. 2018;71(19):2162–75. https://doi.org/10.1016/j.jacc.2018.03.023.

    Article  CAS  PubMed  Google Scholar 

  97. Mitra S, De A, Chowdhury A. Epidemiology of non-alcoholic and alcoholic fatty liver diseases. Transl Gastroenterol Hepatol. 2020;5:16. https://doi.org/10.21037/tgh.2019.09.08.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Mallappallil M, Friedman EA, Delano BG, McFarlane SI, Salifu MO. Chronic kidney disease in the elderly: evaluation and management. Clin Pract. 2014;11(5):525–35. https://doi.org/10.2217/cpr.14.46.

    Article  CAS  Google Scholar 

  99. Dager WE, Kiser TH. Systemic anticoagulation considerations in chronic kidney disease. Adv Chronic Kidney Dis. 2010;17(5):420–7. https://doi.org/10.1053/j.ackd.2010.06.002.

    Article  PubMed  Google Scholar 

  100. Limdi NA, Beasley TM, Baird MF, Goldstein JA, McGwin G, Arnett DK, et al. Kidney function influences warfarin responsiveness and hemorrhagic complications. J Am Soc Nephrol. 2009;20(4):912–21. https://doi.org/10.1681/ASN.2008070802.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  101. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093–100. https://doi.org/10.1378/chest.10-0134.

    Article  PubMed  Google Scholar 

  102. Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151(3):713–9. https://doi.org/10.1016/j.ahj.2005.04.017.

    Article  PubMed  Google Scholar 

  103. Padrini R. Clinical pharmacokinetics and pharmacodynamics of direct oral anticoagulants in patients with renal failure. Eur J Drug Metab Pharmacokinet. 2019;44(1):1–12. https://doi.org/10.1007/s13318-018-0501-y.

    Article  CAS  PubMed  Google Scholar 

  104. Jain N, Reilly RF. Clinical pharmacology of oral anticoagulants in patients with kidney disease. Clin J Am Soc Nephrol. 2019;14(2):278–87. https://doi.org/10.2215/CJN.02170218.

    Article  CAS  PubMed  Google Scholar 

  105. Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged >/=65 years - United States, 2014. MMWR Morb Mortal Wkly Rep. 2016;65(37):993–8. https://doi.org/10.15585/mmwr.mm6537a2.

    Article  PubMed  Google Scholar 

  106. O’Loughlin JL, Robitaille Y, Boivin JF, Suissa S. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 1993;137(3):342–54. https://doi.org/10.1093/oxfordjournals.aje.a116681.

    Article  PubMed  Google Scholar 

  107. Franko J, Kish KJ, O’Connell BG, Subramanian S, Yuschak JV. Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma. J Trauma. 2006;61(1):107–10. https://doi.org/10.1097/01.ta.0000224220.89528.fc.

    Article  CAS  PubMed  Google Scholar 

  108. Shearer MJ, Fu X, Booth SL. Vitamin K nutrition, metabolism, and requirements: current concepts and future research. Adv Nutr. 2012;3(2):182–95. https://doi.org/10.3945/an.111.001800.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Holbrook AM, Pereira JA, Labiris R, McDonald H, Douketis JD, Crowther M, et al. Systematic overview of warfarin and its drug and food interactions. Arch Intern Med. 2005;165(10):1095–106. https://doi.org/10.1001/archinte.165.10.1095.

    Article  CAS  PubMed  Google Scholar 

  110. Crader MF, Johns T, Arnold JK. Warfarin drug interactions. Treasure Island, FL: StatPearls; 2020.

    Google Scholar 

  111. Shireman TI, Howard PA, Kresowik TF, Ellerbeck EF. Combined anticoagulant-antiplatelet use and major bleeding events in elderly atrial fibrillation patients. Stroke. 2004;35(10):2362–7. https://doi.org/10.1161/01.STR.0000141933.75462.c2.

    Article  CAS  PubMed  Google Scholar 

  112. Cochran KA, Cavallari LH, Shapiro NL, Bishop JR. Bleeding incidence with concomitant use of antidepressants and warfarin. Ther Drug Monit. 2011;33(4):433–8. https://doi.org/10.1097/FTD.0b013e318224996e.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  113. Fiske A, Wetherell JL, Gatz M. Depression in older adults. Annu Rev Clin Psychol. 2009;5:363–89. https://doi.org/10.1146/annurev.clinpsy.032408.153621.

    Article  PubMed  PubMed Central  Google Scholar 

  114. Blazer DG. Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci. 2003;58(3):249–65. https://doi.org/10.1093/gerona/58.3.m249.

    Article  PubMed  Google Scholar 

  115. Shao H, Chen LQ, Xu J. Treatment of dyslipidemia in the elderly. J Geriatr Cardiol. 2011;8(1):55–64. https://doi.org/10.3724/SP.J.1263.2011.00055.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Nallammai Muthiah & Nitin Agarwal

  2. Neurotrauma, Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA

    Nitin Agarwal

  3. Spine Fellowship Program, Residency Site Program, Department of Neurological Surgery, UPMC Mercy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    David Kojo Hamilton

Authors
  1. Nallammai Muthiah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nitin Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Kojo Hamilton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Kojo Hamilton .

Editor information

Editors and Affiliations

  1. Weill Cornell Medical College, New York, NY, USA

    Kai-Ming G. Fu

  2. Departments of Neurosurgery & Rehab Medicine, University of Miami School of Medicine, Miami, FL, USA

    Michael Y. Wang

  3. Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY, USA

    Michael S. Virk

  4. Dept. of Orthopedic Surgery, Leatherman Spine Center, University of Louisville, Louisville, KY, USA

    John R. Dimar II

  5. UCSF Neurosurgery, San Francisco, CA, USA

    Praveen V. Mummaneni

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Muthiah, N., Agarwal, N., Hamilton, D.K. (2023). Antithrombotic Management in Spine Surgery in the Elderly. In: Fu, KM.G., Wang, M.Y., Virk, M.S., Dimar II, J.R., Mummaneni, P.V. (eds) Treatment of Spine Disease in the Elderly. Springer, Cham. https://doi.org/10.1007/978-3-031-12612-3_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-12612-3_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-12611-6

  • Online ISBN: 978-3-031-12612-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation