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Study design <p>Retrospective cohort study.</p> Objectives <p>To examine whether early chemoprophylaxis, compared with no chemoprophylaxis, is associated with a reduced risk of venous thromboembolism (VTE) and bleeding complications after spine surgery for acute central cord syndrome (CCS).</p> Setting <p>Multi-site academic centers.</p> Methods <p>This pre-registered study using the TriNetX database included adults who underwent primary cervical spine surgery the same day they sustained a CCS. After excluding those with very high VTE risk or prior VTE, we divided participants into cohorts depending on the administration of chemoprophylaxis (heparin or enoxaparin; chemoprophylaxis cohort) versus no chemoprophylaxis (no chemoprophylaxis cohort) within the first three days after surgery. Outcomes through three months included the incidence and risk ratio (RR) of VTE (primary), pulmonary embolism (PE), deep venous thrombosis (DVT), and deceased status. Cohorts were propensity matched according to key risk factors.</p> Results <p>There were 2417 participants per matched cohort with high follow-up retention (98%). Between cohorts, there was no statistically significant or clinically meaningful difference in the risk of VTE (p = 0.375) over three months’ follow-up. Furthermore, there was no statistically significant difference in the risk of PE (p = 0.762) or DVT (p = 0.384). We were unable to assess the risk of epidural hematoma or severe postoperative bleeding as both outcomes were rare.</p> Conclusion <p>Early postoperative chemoprophylaxis was not associated with reduced VTE risk compared with no chemoprophylaxis after spine surgery for acute CCS in adults. These findings do not provide evidence supporting routine chemoprophylaxis use in CCS participants after surgery. However, clinical decisions should remain individualized, particularly for higher-risk participants.</p>

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Association between early chemoprophylaxis versus no chemoprophylaxis and risk of venous thromboembolism and bleeding complications after same-day spine surgery for central cord syndrome: a retrospective cohort analysis

  • 期刊论文

  • 发表日期：

    2026年5月10日

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  • Anthony N. Baumann,
  • Nathan Cuttica,
  • Harris Skaramagas,
  • Robert J. Trager,
  • Davin C. Gong,
  • Gregory Hawryluk

摘要

Study design

Retrospective cohort study.

Objectives

To examine whether early chemoprophylaxis, compared with no chemoprophylaxis, is associated with a reduced risk of venous thromboembolism (VTE) and bleeding complications after spine surgery for acute central cord syndrome (CCS).

Setting

Multi-site academic centers.

Methods

This pre-registered study using the TriNetX database included adults who underwent primary cervical spine surgery the same day they sustained a CCS. After excluding those with very high VTE risk or prior VTE, we divided participants into cohorts depending on the administration of chemoprophylaxis (heparin or enoxaparin; chemoprophylaxis cohort) versus no chemoprophylaxis (no chemoprophylaxis cohort) within the first three days after surgery. Outcomes through three months included the incidence and risk ratio (RR) of VTE (primary), pulmonary embolism (PE), deep venous thrombosis (DVT), and deceased status. Cohorts were propensity matched according to key risk factors.

Results

There were 2417 participants per matched cohort with high follow-up retention (98%). Between cohorts, there was no statistically significant or clinically meaningful difference in the risk of VTE (p = 0.375) over three months’ follow-up. Furthermore, there was no statistically significant difference in the risk of PE (p = 0.762) or DVT (p = 0.384). We were unable to assess the risk of epidural hematoma or severe postoperative bleeding as both outcomes were rare.

Conclusion

Early postoperative chemoprophylaxis was not associated with reduced VTE risk compared with no chemoprophylaxis after spine surgery for acute CCS in adults. These findings do not provide evidence supporting routine chemoprophylaxis use in CCS participants after surgery. However, clinical decisions should remain individualized, particularly for higher-risk participants.