title: Thrombophilic abnormalities in patients with or without pulmonary embolism following elective spinal surgery: a pilot study.
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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  These findings suggest the involvement of thrombophilic abnormalities, especially the heterozygous G20201A mutation, in the development of PE in patients undergoing elective spinal surgery.
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Department of Orthopedic Surgery, Truman Medical Center, Hospital Hill, 2301 Holmes Street, Kansas City, MO 64108 USA.
authors.forename: Suhel
authors.initials: S
authors.lastname: Kotwal
authors.affiliation: Department of Orthopaedic Surgery, Sapporo Medical University, South 1, West 16, Sapporo, 060-8543 Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kawaguchi
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Weill Cornell College of Medicine, New York, NY 10065 USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Hughes
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Weill Cornell College of Medicine, New York, NY 10065 USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Cammisa
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Weill Cornell College of Medicine, New York, NY 10065 USA.
authors.forename: Kai
authors.initials: K
authors.lastname: Zhang
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Weill Cornell College of Medicine, New York, NY 10065 USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Salvati
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Weill Cornell College of Medicine, New York, NY 10065 USA.
authors.forename: Federico
authors.initials: F
authors.lastname: Girardi
keywords: elective spinal surgery; gene mutation; pulmonary embolism; thrombophilia; venous thromboembolism