Is Blood Loss Greater in Elderly Patients under Antiplatelet or Anticoagulant Medication for Cervical Spine Injury Surgery? A Japanese Multicenter Survey

  • Uehara Masashi
    Department of Orthopaedic Surgery, Shinshu University School of Medicine
  • Ikegami Shota
    Department of Orthopaedic Surgery, Shinshu University School of Medicine
  • Takizawa Takashi
    Department of Orthopaedic Surgery, Shinshu University School of Medicine
  • Oba Hiroki
    Department of Orthopaedic Surgery, Shinshu University School of Medicine
  • Yokogawa Noriaki
    Department of Orthopaedic Surgery, Graduate School of Medical Sciences
  • Sasagawa Takeshi
    Department of Orthopaedic Surgery, Graduate School of Medical Sciences Department of Orthopedics Surgery, Toyama Prefectural Central Hospital
  • Ando Kei
    Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
  • Nakashima Hiroaki
    Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
  • Segi Naoki
    Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
  • Funayama Toru
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba
  • Eto Fumihiko
    Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Yamaji Akihiro
    Department of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital
  • Watanabe Kota
    Department of Orthopaedic Surgery, Keio University School of Medicine
  • Nori Satoshi
    Department of Orthopaedic Surgery, Keio University School of Medicine
  • Takeda Kazuki
    Department of Orthopaedic Surgery, Keio University School of Medicine Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital
  • Furuya Takeo
    Department of Orthopaedic Surgery, Graduate School of Medicine
  • Orita Sumihisa
    Department of Orthopaedic Surgery, Graduate School of Medicine Chiba University Center for Frontier Medical Engineering (CFME)
  • Nakajima Hideaki
    Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui
  • Yamada Tomohiro
    Department of Orthopaedic Surgery, Hamamatsu University School of Medicine Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital
  • Hasegawa Tomohiko
    Department of Orthopaedic Surgery, Hamamatsu University School of Medicine
  • Terashima Yoshinori
    Department of Orthopaedic Surgery, Sapporo Medical University Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital
  • Hirota Ryosuke
    Department of Orthopaedic Surgery, Sapporo Medical University
  • Suzuki Hidenori
    Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine
  • Imajo Yasuaki
    Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine
  • Tonomura Hitoshi
    Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
  • Sakata Munehiro
    Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Department of Orthopaedics, Saiseikai Shiga Hospital
  • Hashimoto Ko
    Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
  • Onoda Yoshito
    Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
  • Kawaguchi Kenichi
    Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
  • Haruta Yohei
    Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
  • Suzuki Nobuyuki
    Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences
  • Kato Kenji
    Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences
  • Uei Hiroshi
    Department of Orthopaedic Surgery, Nihon University Hospital Department of Orthopaedic Surgery, Nihon University School of Medicine
  • Sawada Hirokatsu
    Department of Orthopaedic Surgery, Nihon University School of Medicine
  • Nakanishi Kazuo
    Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School
  • Misaki Kosuke
    Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School
  • Terai Hidetomi
    Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine
  • Tamai Koji
    Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine
  • Shirasawa Eiki
    Department of Orthopaedic Surgery, Kitasato University School of Medicine
  • Inoue Gen
    Department of Orthopaedic Surgery, Kitasato University School of Medicine
  • Kakutani Kenichiro
    Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine
  • Kakiuchi Yuji
    Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine
  • Kiyasu Katsuhito
    Department of Orthopaedic Surgery, Kochi Medical School, Kochi University
  • Tominaga Hiroyuki
    Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Tokumoto Hiroto
    Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University
  • Iizuka Yoichi
    Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine
  • Takasawa Eiji
    Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine
  • Akeda Koji
    Department of Orthopaedic Surgery, Mie University Graduate School of Medicine
  • Takegami Norihiko
    Department of Orthopaedic Surgery, Mie University Graduate School of Medicine
  • Funao Haruki
    Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital
  • Oshima Yasushi
    Department of Orthopaedic Surgery, The University of Tokyo Hospital
  • Kaito Takashi
    Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine
  • Sakai Daisuke
    Department of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine
  • Yoshii Toshitaka
    Department of Orthopaedic Surgery, Tokyo Medical and Dental University
  • Ohba Tetsuro
    Department of Orthopaedic Surgery, University of Yamanashi
  • Otsuki Bungo
    Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University
  • Seki Shoji
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama
  • Miyazaki Masashi
    Department of Orthopaedic Surgery, Faculty of Medicine, Oita University
  • Ishihara Masayuki
    Department of Orthopaedic Surgery, Kansai Medical University Hospital
  • Okada Seiji
    Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine
  • Aoki Yasuchika
    Department of Orthopaedic Surgery, Eastern Chiba Medical Center
  • Harimaya Katsumi
    Department of Orthopaedic Surgery, Kyushu University Beppu Hospital
  • Murakami Hideki
    Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences
  • Ishii Ken
    Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital
  • Ohtori Seiji
    Department of Orthopaedic Surgery, Graduate School of Medicine
  • Imagama Shiro
    Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
  • Kato Satoshi
    Department of Orthopaedic Surgery, Graduate School of Medical Sciences

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<p>Introduction: In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly. The present multicenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma.</p><p>Methods: The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well.</p><p>Results: Of the 776 patients (mean age: 75.1±6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases.</p><p>Conclusions: This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly.</p>

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