Asian Spine J.  2017 Dec;11(6):898-902. 10.4184/asj.2017.11.6.898.

Postoperative Spinal Epidural Hematoma: The Danger Caused by the Misuse of Thrombin-Containing Local Hemostatics

Affiliations
  • 1Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea. dr.wonshik@hanmail.net

Abstract

STUDY DESIGN: Retrospective case-control study. PURPOSE: To examine the hypothesis that the misuse of thrombin-containing local hemostatics (TCLH) increases the risk of postoperative spinal epidural hematoma (POSEH). OVERVIEW OF LITERATURE: Many studies have focused on hypocoagulability as a risk factor for POSEH. However, there are no prior reports on the increased risk of POSEH in hypercoagulable states.
METHODS
Posterior instrumented lumbar spine surgery cases over 2 consecutive years were divided into two groups: a study group (98 patients in whom TCLH was used) and a control group (176 patients in whom TCLH was not used). The excess TCLH matrix that was not associated with blood clot was not removed from the patients in the study group. The senior author decided whether to use TCLH or not. Suction drains were used in all patients. The demographics, coagulation-related factors, and intraoperative factors of the patients in the two groups were analyzed. The development of POSEH was compared between the two groups.
RESULTS
The two groups were homogenous in demographics (age and sex), coagulation-related factors (platelet count, prothrombin time, activated partial thromboplastin time, and platelet function analysis), and surgical factors (total blood loss, operation time, blood loss/10 minutes, number of fusion segments, posterolateral fusion/posterior lumbar interbody fusion, and virgin or revision surgery). POSEH developed more frequently in the patients in the study group than in those in the control group (14/98 patients, 14.3% vs. 3/176 patients, 1.7%, respectively; p=0.001; odds ratio, 17.1).
CONCLUSIONS
TCLH causes blood clot not only at the edge of damaged vessels but also at the site of extravascular blood. Excess TCLH matrix not associated with blood clot at the epidural space can enhance POSEH development because early clotted hematomas do not drain through suction drains.

Keyword

Postoperative spinal epidural hematoma; Thrombin-containing local hemostatics

MeSH Terms

Blood Platelets
Case-Control Studies
Demography
Epidural Space
Hematoma
Hematoma, Epidural, Spinal*
Hemostatics*
Humans
Odds Ratio
Partial Thromboplastin Time
Prothrombin Time
Retrospective Studies
Risk Factors
Spine
Suction
Hemostatics
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