title: Is chemical antithrombotic prophylaxis effective in elective thoracolumbar spine surgery? Results of a systematic review.
abstract: METHODS
  Systematic review Study rationale and context:  There is controversy regarding the efficacy and safety of chemical prophylaxis to prevent deep venous thrombosis (DVT) and pulmonary embolism (PE) in elective spinal procedures.Commonly performed elective spine surgeries done through a posterior approach have a very low associated risk of DVT/PE. The lack of consensus is due in part to a limited amount of quality evidence based literature dealing with this issue.
  
  
  OBJECTIVE
  To compare chemical prophylaxis with no chemical prophylaxis in preventing venous thromboembolism in elective thoracolumbar spine surgery.
  
  
  METHODS
  We undertook a systematic review of the literature to assess the efficacy and safety of chemical prophylaxis in preventing venous thromboembolism in elective thoracolumbar spine surgery. Pubmed, EMBASE, Cochrane, National Guideline Clearinghouse Databases as well as bibliographies of key articles were searched. Articles were reviewed by two independently working reviewers. Inclusion and exclusion criteria were set and each article was subject to a predefined quality rating scheme.
  
  
  RESULTS
  We identified only two articles meeting our inclusion criteria. Neither study demonstrated a significant difference between chemical prophylaxis versus no prophylaxis in preventing thromboembolic events. There was an increased incidence of perioperative bleeding with low dose Coumadin in one of the studies.
  
  
  CONCLUSIONS
  The incidence of DVT and PE in commonly performed elective posterior spinal procedures is very low. While there is a limited amount of randomized literature looking at this issue, the current literature does not support the routine use of chemical prophylaxis for low risk patients undergoing these procedures.
authors: Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: James M
authors: JM
authors: Schuster
authors: Dena
authors: D
authors: Fischer
authors: Joseph R
authors: JR
authors: Dettori
keywords: Venous thromboembolism; bleeding; chemical prophylaxis; deep venous thrombosis; pulmonary embolism; spine surgery
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