The Morbidity of Heparin Therapy After Development of Pulmonary Embolus in Patients Undergoing Thoracolumbar or Lumbar Spinal Fusion

Abstract

The postoperative course of patients who developed a pulmonary embolus after thoracolumbar or lumbar spinal fusion treated with heparin was studied to quantify the morbidity risk of anticoagulation. To compare the morbidity risk of heparinization with that of an alternative form of therapy--inferior vena cava filter placement. Therapeutic heparinization was the current treatment of choice for patients who develop thromboembolic disease after surgery. Although heparin usage was reported to be associated with a number of complications after other orthopedic and general surgical procedures, no information was available to identify complications of heparinization after lumbar or thoracolumbar spine surgery or to define the risk of such complications. Twenty-two members of the Scoliosis Research Society were polled to determine their experiences with the anticoagulation of this subset of patients. Surgeons polled had a combined experience of 250 man-years and had performed more than 13000 thoracolumbar and lumbar spinal fusions. The MEDLINE database was used to review pertinent English language publications describing inferior vena cava filter complications, effectiveness, safety, and indications for use. Nine patients were located who fit the inclusion criteria of this study. Six (67%) had complications attributable to heparinization. Clinically significant complications of filter placement ranged from 0.12% to 10.1%. Heparinization after the development of pulmonary embolus in patients recently undergoing spinal fusion is associated with a high complication rate. The morbidity of vena cava filter placement is low and should be considered a treatment alternative in the treatment of patients who experience pulmonary embolus after surgery.