The Effectiveness and Safety of Chemoprophylaxis in the Surgical Management of Spinal Trauma: A Systematic Review and Meta-Analysis

Objective: Chemoprophylaxis for preventing venous thromboembolism (VTE) in spine surgery is debated due to effectiveness and safety concerns. Guidelines lack consensus on regimens and timing for spinal trauma. We examined chemoprophylaxis in spine trauma surgery to further guide surgeon decision-making.

Methods: This systematic review and meta-analysis searched PubMed, CINAHL, MEDLINE, and Web of Science until March 14, 2024, for articles on chemoprophylaxis and spine trauma surgery. A random-effects meta-analysis compared VTE events by chemoprophylaxis use and timing.

Results: Fourteen observational studies (n = 13,754 patients; mean age: 41.74 ± 9.09 years; mean follow-up: 76.98 ± 213.45 days) were included. The total VTE prevalence was 6.28% (425/6771). VTE prevalence was 4.08% (143/3502) with chemoprophylaxis and 8.62% (282/3269) without. Meta-analysis showed no significant VTE difference between patients with (n = 516; 3.88%) and without chemoprophylaxis (n = 528; 5.68%) (P = 0.119, relative risk [RR]: 1.03; 95% confidence interval [CI]: [0.99, 1.08]). No significant difference in postoperative bleeding was found between patients with (3.01% of 722 patients) and without chemoprophylaxis (5.74% of 766 patients) (P = 0.549, RR: 1.00; 95% CI: [0.99, 1.02]). Comparing early (n = 305; 5.90%) and late chemoprophylaxis (n = 271; 8.86%) showed no significant VTE difference (P = 0.289, RR: 1.06; 95% CI: [0.96, 1.14]). Postoperative bleeding was also not significantly different between early (n = 305; no complications) and late chemoprophylaxis (2.58%) (P = 0.328, RR: 1.14; 95% CI: [0.88, 1.48]).

Conclusions: No significant association was found between chemoprophylaxis use or timing and VTE risk after spine trauma surgery, though this finding may be underpowered. Chemoprophylaxis did not appear to significantly increase postoperative bleeding.