The influence of antiplatelet drugs on outcomes of spinal surgery: A systematic review and meta-analysis

Introduction: The management of antiplatelet therapy (APT) in patients undergoing spinal surgery is complex, requiring balancing the risks of thromboembolic events against those of potential perioperative bleeding. This review evaluates the effects of continuing versus discontinuing APT on the surgical outcomes of spinal surgery.

Hypothesis: The hypothesis is that continuing antiplatelet therapy (APT) in patients undergoing spinal surgery will not significantly increase intraoperative blood loss, operative time, or postoperative complications compared to discontinuing APT, but may lead to a higher need for postoperative transfusions.

Material and methods: Systematic search was done in EMBASE, Scopus, PubMed Central, Google Scholar, and ScienceDirect databases for studies comparing the continuation of APT to its discontinuation in terms of estimated blood loss, operative time, hospital stay length, postoperative transfusion units, postoperative complications, postoperative hematoma, readmission rate, cardiovascular events amongst patients undergoing spinal surgery. Risk of bias was assessed with the Newcastle Ottawa scale and synthesized the data using random-effects meta-analyses, summarizing outcome results as either standardized mean differences (SMDs) or odds ratios (ORs) as appropriate.

Results: 13 studies were included in meta-analysis. Similar estimated blood losses (SMD = 0.125; 95%CI, -0.087 to 0.337) and operative times (SMD = 0.231; 95%CI, -0.225 to 0.687) were found between the patients who continued and those who discontinued the APT. However, patients who continued APT had a slightly higher chance of requiring postoperative transfusions (SMD = 0.244; 95%CI, 0.030 to 0.458). Similar hospital stay lengths, and postoperative complication or cardiovascular event rates were found.

Discussion: Continuing APT during spinal surgery does not significantly increase the risks of intraoperative blood loss or increase the operative time, however; it may increase the need for postoperative transfusions. These findings suggest that for patients at risk of thromboembolic events, the benefits of continuing APT outweigh the risks.

Level of evidence: III; Systematic Review and Meta-analysis.