Does intraoperative subcutaneous heparin or tranexamic acid affect rate of vascular complications in Anterior Lumbar Interbody Fusion procedures?

Introduction: Anterior lumbar interbody fusion (ALIF) is a surgical technique commonly used to treat degenerative disc disease in the lower lumbar spine. As the procedure commonly involves retraction of the iliac arteries and veins, potential complications include deep vein thrombosis (DVT) and hemorrhagic vessel injuries. At our institution, there is practice heterogeneity in the use of prothrombotic and antithrombotic agents during ALIF procedures. The goal of this study is to assess whether the use of intraoperative tranexamic acid (TXA), subcutaneous heparin (SQH), or neither is associated with hospitalization outcomes and increased risk of vascular complications.

Methods: A retrospective review of patients who had undergone ALIF at a large tertiary academic center from 2015 to 2023 was performed. Patient demographics and surgical characteristics were extracted. Pain scores and neurologic deficits at presentation and 1-3 month follow-up were recorded. Logistic regressions, ANOVA tests, and Chi-Squared analyses were performed on categorical variables.

Results: One hundred eighty-nine patients were included; there were 86 (45.6%) females and an average age of 58.7+/-13.3 years. Twenty-two patients received SQH, 35 patients received TXA, and 115 received neither. There were no significant differences between coagulation intervention and intra- or post-operative complication rate, change in post-operative motor function (p = 0.1468), or change in post-operative VAS pain reporting (p = 0.216). No differences were found between length of hospital stay and coagulation intervention after correcting for staged procedures (p = 0.422). Although not statistically significant (p = 0.071), there was a decreased estimated blood loss with no intervention (337.6 ± 651 mL), SQH (242 ± 221.6 mL), and TXA (135 ± 211.8 mL). Additionally, patients with no intervention were more likely to receive blood transfusions (16, 20.8%), than patients receiving SQH (1, 5.56%) and TXA (0) (p = 0.011).

Conclusion : The use of perioperative SQH or TXA in ALIF procedures did not result in statistically significant differences in complication rates, motor function change, hospital length of stay, or estimated blood loss. Statistically significant differences were found with the use of coagulative intervention and blood transfusions.