Thrombophilic abnormalities in patients with or without pulmonary embolism following elective spinal surgery: a pilot study

Correlation between PAI-1 rs1799889 polymorphism and venous thromboembolism: A meta-analysis of 48 case-control studies

BACKGROUND

We performed this meta-analysis to better assess the relationship between plasminogen activator inhibitor-1 (PAI-1) rs1799889 polymorphism and the risk of venous thromboembolism.

METHOD

Eligible studies were searched in PubMed, Medline, Embase, Web of Science and CNKI. Odds ratios with 95% confidence intervals were calculated.

RESULT

A total of 48 studies with 14,806 participants were analyzed. No positive results were detected in overall analyses. Further subgroup analyses revealed that the PAI-1 rs1799889 polymorphism was significantly associated with the risk of venous thromboembolism in Caucasians and East Asians. When we stratified available data according to type of disease, we found that the PAI-1 rs1799889 polymorphism was significantly correlated with the risk of DVT. No any other positive results were observed in overall and subgroup analyses.

CONCLUSION

Our findings indicate that the PAI-1 rs1799889 polymorphism may serve as a potential biological marker for venous thromboembolism in Caucasians and East Asians.

A Successful Collaborative Approach to the Perioperative Management After Hip Arthroscopy of a Patient with Heterozygous Prothrombin G20210A Mutation: A Case Report

CASE

We report on a patient with heterozygous prothrombin G20210A mutation (PTM) and a history of venous thromboembolism (VTE) after knee arthroscopy, who was undergoing hip arthroscopy. This common mutation has an overall prevalence of 2.0% and results in a 280% to 420% likelihood of thrombosis compared to patients without the mutation.

CONCLUSIONS

Hip arthroscopy is associated with a low risk of VTE with currently no guidelines for thromboprophylaxis. Patients should be managed in relation to their risk factors utilizing a collaborative, individualized approach. Treatment with short-term low-molecular-weight heparin resulted in no thromboembolism at 18-month follow-up for this patient with PTM.

The Effect of Coagulopathies on Perioperative Complications and Clinical Outcomes in Patients Treated With Posterior Lumbar Fusions

STUDY DESIGN

A retrospective database review.

OBJECTIVE

The aim of this study was to compare complication rates following one to two-level lumbar spine surgery in patients with primary hypercoagulable states and coagulopathies.

SUMMARY OF BACKGROUND DATA

Both hypercoagulable states and coagulopathies are not uncommon conditions that have the potential to significantly alter perioperative patient management. However, there are few studies that document the added risk of medical complications following spine surgery in these patient populations.

METHODS

The PearlDiver database (2005-2012) was utilized to determine perioperative complication rates in patients with primary hypercoagulable states and coagulopathies who underwent primary one to two-level posterolateral lumbar spine fusion. Control cohorts without specific hematologic disorders were matched by demographics and comorbidities. Ninety-day complication rates were determined, along with revision rates at one and two years. When considering complication rate comparisons between matched cohorts, P < 0.005 was considered significant.

RESULTS

In total, 746 patients with coagulopathies and 2753 patients with primary hypercoagulable states were selected. Matched control cohorts contained 74,879 and 54,007 patients, respectively. Hypercoagulable patients had significantly increased rates of medical complications [odds ratio (OR) 1.4], infections (OR 1.6), and venous thromboembolisms (OR 9.0) during the three months following spine surgery and same-day transfusions (OR 1.2) when compared with matched controls (P < 0.001). Patients with von Willebrand disease or hemophilia had increased rates of three-month infections (OR 2.3) and transfusion (OR 2.0) when compared with a matched control group (P < 0.005). One- and two-year revisions rates were not significantly higher for either pathologic cohort when compared to matched controls.

CONCLUSION

Both primary hypercoagulable states and coagulopathies increase infection and transfusion rates following one to two-level lumbar spine surgery.

LEVEL OF EVIDENCE

3.