• Omkar S Anaspure, Anthony N Baumann, Andrew Fiorentino, Katelyn Sidloski, Jared B Hinton, Keegan T Conry, Gordon Preston, and Jacob C Hoffmann.
• Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: Omkar.Anaspure@pennmedicine.upenn.edu.
• World Neurosurg. 2024 Dec 27; 194: 123554123554.

ObjectiveChemoprophylaxis for preventing venous thromboembolism (VTE) in spine surgery is debated due to effectiveness and safety concerns. Guidelines lack consensus on regimens and timing for spinal trauma. We examined chemoprophylaxis in spine trauma surgery to further guide surgeon decision-making.MethodsThis systematic review and meta-analysis searched PubMed, CINAHL, MEDLINE, and Web of Science until March 14, 2024, for articles on chemoprophylaxis and spine trauma surgery. A random-effects meta-analysis compared VTE events by chemoprophylaxis use and timing.ResultsFourteen observational studies (n = 13,754 patients; mean age: 41.74 ± 9.09 years; mean follow-up: 76.98 ± 213.45 days) were included. The total VTE prevalence was 6.28% (425/6771). VTE prevalence was 4.08% (143/3502) with chemoprophylaxis and 8.62% (282/3269) without. Meta-analysis showed no significant VTE difference between patients with (n = 516; 3.88%) and without chemoprophylaxis (n = 528; 5.68%) (P = 0.119, relative risk [RR]: 1.03; 95% confidence interval [CI]: [0.99, 1.08]). No significant difference in postoperative bleeding was found between patients with (3.01% of 722 patients) and without chemoprophylaxis (5.74% of 766 patients) (P = 0.549, RR: 1.00; 95% CI: [0.99, 1.02]). Comparing early (n = 305; 5.90%) and late chemoprophylaxis (n = 271; 8.86%) showed no significant VTE difference (P = 0.289, RR: 1.06; 95% CI: [0.96, 1.14]). Postoperative bleeding was also not significantly different between early (n = 305; no complications) and late chemoprophylaxis (2.58%) (P = 0.328, RR: 1.14; 95% CI: [0.88, 1.48]).ConclusionsNo significant association was found between chemoprophylaxis use or timing and VTE risk after spine trauma surgery, though this finding may be underpowered. Chemoprophylaxis did not appear to significantly increase postoperative bleeding.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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