The Likelihood of Wound Complications Following the Use of Rivaroxaban as a Thrombo-Prophylactic Agent in Patients Undergoing Spinal Canal Stenosis Surgery: A Case Series
Background: Wound complications are major morbidities after orthopedic surgery, and thrombo-prophylactic drugs may increase the likelihood of such complications. In this regard, our study has evaluated the possible effects of rivaroxaban on wound complication issues following spinal canal stenosis surgery.
Methods: This prospective cohort study was conducted on 40 patients suffering from spinal canal stenosis secondary to degenerative lumbar spine changes. The eligible patients included those patients receiving rivaroxaban to prevent thrombo-emboli post-operatively. The patients were followed up for three months and assessed for postoperative wound-related complications.
Results: None of the patients suffered vascular and thromboembolic complications. Regarding wound complications, these events are mostly limited to the first week post-operatively, including wound dehiscence in 5.0%, serosanguineous discharge in 25.0%, erythema in 35.0%, superficial infection in 10.0%, requiring surgical debridement in 5.0%, cellulitis in 10.0%, and wound induration in 30.0%. Deep infection or hematoma was not reported in our patients. Erythema and wound induration remained 10.0% and 15.0% within the second week, respectively. The hypertrophic scar was a delayed complication that appeared in 15.0% of patients within 1 to 3 months post-operatively.
Conclusion: The main risk profiles related to wound complications, especially infections, were a history of hypertension (HTN), uncontrolled diabetes mellitus (DM), and renal insufficiency. The use of rivaroxaban may be accompanied by temporary and minor wound complications and not with potentially debilitating morbidity in patients undergoing spinal canal stenosis surgery. Therefore, its prescription as a safe thrombo-prophylactic drug in patients undergoing spinal canal stenosis surgery is confidently recommended.
2. Ghasemi MA, Ghadimi E, Shamabadi A, Mortazavi SM. The perioperative management of antiplatelet and anticoagulant drugs in hip fractures: Do the surgery as early as possible. Arch Bone Jt Surg. 2022;10(6):490-500.
3. Sanchez C, Nguyen J, Baroutjian A, Gill S, McKenney M, Elkbuli
A. Venous thromboembolism chemoprophylaxis in trauma and emergency general surgery patients: A systematic review. J Trauma Nurs. 2021;28(5):323-31. doi: 10.1097/JTN.0000000000000606. [PubMed: 34491950].
4. Viana LMAT, Nogueira IAL, Fontenele AMM, Oliveira LP. Thromboembolism in arthroplasty: Compliance to prophylaxis. Rev Bras Ortop (Sao Paulo). 2021;56(5):647-55. doi: 10.1055/s-0041-1731657. [PubMed: 34733438]. [PubMed Central: PMC8558933].
5. Hu B, Jiang L, Tang H, Hu M, Yu J, Dai Z. Rivaroxaban versus aspirin in prevention of venous thromboembolism following total joint arthroplasty or hip fracture surgery: A meta- analysis. J Orthop Surg Res. 2021;16(1):135. doi: 10.1186/s13018- 021-02274-z. [PubMed: 33581718]. [PubMed Central: PMC7881643].
6. Feng W, Wang X, Huang D, Lu A. Ranking the efficacy of anticoagulants for the prevention of venous thromboembolism after total hip or knee arthroplasty: A systematic review and a network meta-analysis. Pharmacol Res. 2021;166:105438. doi: 10.1016/j.phrs.2021.105438. [PubMed: 33540046].
7. Rashki KA, Abutorabi A, Alipour V. Economic evaluation of rivaroxaban versus enoxaparin for prevention of venous thromboembolism after total knee replacement and total hip replacement: A systematic review. Clin Drug Investig. 2020;40(8): 715-25. doi: 10.1007/s40261-020-00940-4. [PubMed: 32578155].
8. Dong Y, Duan G, Wang H, Ru J, Cui Y. A cohort study of rivaroxaban combined with D-dimer dynamic monitoring in the prevention of deep venous thrombosis after knee arthroplasty. Comput Math Methods Med. 2022;2022:3965039. doi: 10.1155/2022/3965039. [PubMed: 35495880]. [PubMed Central: PMC9042632].
9. Panagopoulos D, Karydakis P, Noutsos G, Themistocleous M. Venous thromboembolism risk and thromboprophylaxis in pediatric neurosurgery and spinal injury: Current trends and literature review. Semin Thromb Hemost. 2022;48(3):318-22. doi: 10.1055/s-0041-1733959. [PubMed: 34624914].
10. Banat M, Wach J, Salemdawod A, Bara G, Shabo E, Scorzin JE, et al. Antithrombotic therapy in spinal surgery does not impact patient safety-a single center cohort study. Front Surg. 2021;8:791713. doi: 10.3389/fsurg.2021.791713. [PubMed: 35155550]. [PubMed Central: PMC8825487].
11. Deyo RA, Hickam D, Duckart JP, Piedra M. Complications after surgery for lumbar stenosis in a veteran population. Spine (Phila Pa 1976). 2013;38(19):1695-702. doi: 10.1097/BRS.0b013e31829f65c1. [PubMed: 23778366]. [PubMed Central: PMC3865062].
12. Nahhas CR, Hu K, Mehta AI. Incidence and risk factors of wound complications in long segment instrumented thoracolumbar spinal fusions: A retrospective study. J Spine Surg. 2018;4(2):233-40. doi: 10.21037/jss.2018.05.11. [PubMed: 30069512]. [PubMed Central: PMC6046351].
13. Wang MY, Green BA, Shah S, Vanni S, Levi AD. Complications associated with lumbar stenosis surgery in patients older than 75 years of age. Neurosurg Focus. 2003;14(2):e7. 10.3171/foc.2003.14.2.8. [PubMed: 15727428].
14. Collins I, Wilson-MacDonald J, Chami G, Burgoyne W, Vinayakam P, Berendt T, et al. The diagnosis and management of infection following instrumented spinal fusion. Eur Spine J. 2008;17(3):445-50. doi: 10.1007/s00586-007-0559-8. [PubMed: 18075763]. [PubMed Central: PMC2270376].
15. Fang A, Hu SS, Endres N, Bradford DS. Risk factors for infection after spinal surgery. Spine (Phila Pa 1976). 2005;30(12):1460-5. doi: 10.1097/01.brs.0000166532.58227.4f. [PubMed: 15959380].
16. Zarei M, Rostami M, Khan F. Does spine surgery in patients with a history of bariatric gastrectomy increase the risk of delayed pulmonary embolism? J Orthop Spine Trauma. 2022;7(4):154-6. doi: 10.18502/jost.v7i4.8864.
|Issue||Vol 8, No 4 (2022)|
|Cohort Studies Postoperative Complication Spine Surgery Wounds|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|