GUIDELINES FOR PREVENTION OF DEEP VEIN THROMBOSIS IN ELECTIVE SPINAL SURGERY

1. In patients without thromboembolic risk factors*, no routine use of anticoagulant therapy or specific anti-thomboprophylaxis, is recommended other than early and frequent ambulation.

2. In patients with a thromboembolic risk factor*, the recommendation is one of the following –

• post-operative low dose unfractionated heparin
• or post operative low molecular weight heparin,
- either to be continued for hospitalisation period, and thereafter dependent on weighting of risk factors, although no specific guidelines are available to specify time periods in the literature.
• or optimal use of intermittent pneumatic compression and/or graduated compression stockings.

3. In patients with multiple thromboembolic risk factors*, the recommendation is one of the following –

• post-operative low dose unfractionated heparin
• or post operative low molecular weight heparin,
- either to be continued for hospitalisation period, and thereafter dependent on weighting of risk factors, although no specific guidelines are available to specify time periods in the literature.
• AND optimal use of intermittent pneumatic compression and/or graduated compression stockings.

*THROMBOEMBOLIC RISK FACTORS

  1. Advanced age – arbitrary more than 60 years
  2. Prolonged procedure
  3. Reduced pre or post operative mobility
  4. Obesity
  5. Loss of motor function in lower limbs
  6. Previous DVT / P.E
  7. Malignancy
  8. Anterior lumbar spine surgery
  9. Recent major trauma
  10. Hormonal therapy


Posted November 2008