Management of Anticoagulant and Antiplatelet Therapy in Elective Degenerative Lumbosacral Spine Surgery: A Clinical Study on 578 Elderly Patients.

Abstract

Managing anticoagulant and antiplatelet therapy in elderly patients with high cardiovascular risk undergoing degenerative lumbosacral spine surgery is a complex challenge. Balancing the reduction of thromboembolic events and minimizing bleeding risks requires tailored perioperative strategies. This study evaluates the outcomes of a standardized management approach for such therapies in this vulnerable population. A retrospective analysis was conducted on 578 patients aged 60 years or older undergoing elective surgery for lumbar spinal stenosis, lumbar disc herniation, or spondylolisthesis. Patients were categorized into three groups based on their antithrombotic regimen: no therapy (Group A), primary prevention therapy (Group B), and secondary prevention therapy (Group C). Perioperative bridging with enoxaparin or low-dose aspirin was applied where indicated. Clinical outcomes, including surgical duration, blood loss, postoperative complications (Clavien-Dindo scale), and hospitalization length, were assessed. No significant differences were observed in intraoperative blood loss or surgical duration across groups. Hospitalization duration was shorter in Group B compared with Group A for lumbar stenosis ( P = .01) and in Group C compared with Group A for disc herniation ( P < .01). Complications were predominantly Grade I or II, with no major bleeding or cardiovascular events recorded. The management demonstrated safety and efficacy in maintaining cardiovascular protection while controlling bleeding risks. This study highlights the feasibility of individualized perioperative management of antithrombotic therapy in high-risk patients undergoing elective degenerative spine surgery. The findings support the development of standardized management strategies to optimize surgical outcomes without compromising patient safety. Further prospective studies are needed to refine these strategies.