Does the choice of chemoprophylaxis affect the prevention of deep vein thrombosis in lumbar fusion surgery?A systematic review of literature

To date, the available guidance on venous thromboembolism (VTE) prevention in elective lumbar fusion surgery is largely open to surgeon interpretation and preference without any specific suggested chemoprophylactic regimen. This study aims to comparatively analyze the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) with the use of commonly employed chemoprophylactic agents such as unfractionated heparin (UH) and lowmolecularweight heparin (LMWH) in lumbar fusion surgery. Methods: An independent systematic review of four scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed by two authors to identify relevant articles in adherence to the preferred reporting in systematic reviews and meta-analysis (PRISMA) guidelines. Studies reporting on DVT/PE outcomes of lumbar fusion surgery in adult patients with UH or LMWH chemoprophylaxis were included for analysis. Analysis was performed using the Open Meta[Analyst] software. Results: Twelve studies with 8495 patients were included in the analysis. A single-arm meta-analysis of the included studies found an incidence of DVT 11.80 (95%CI [6.40% - 17.10%]) and 1.30% (95%CI [0.50% - 2.10%]) with LMWH and UH respectively. Both the chemoprophylaxis agents prevented PE with a noted incidence of 0% (95%CI [0%- 0.10%]) and 0.40%(95%CI [0%- 0.90%]) with LMWH and UH respectively. The risk of bleeding-related complications with their usage was 0.20% (95% CI [0.10% - 0.30%]). Conclusion: Both LMWH and UH are effective in reducing the overall incidence of DVT/PE, but there is a paucity of evidence analyzing the comparative effectiveness of the chemoprophylaxis regimens in lumbar fusion procedures. The heterogeneity in data prevents any conclusions, as there remains an evidence gap. We recommend future high-quality RCTs to investigate in this regard to help develop recommendations on chromboprophylaxis usage.