抄録
The prevalence of venous thromboembolism (VTE) after spinal surgery is 6.84/10000 operations according to a nationwide survey by the Japanese Anesthesia Association. Prevention of VTE after spinal surgery is basically mechanically achieved as follows: 1: active exercise of the legs; 2: early ambulation; 3: elastic stockings with graded compassion; and 4: intermittent pneumatic compression. However mechanical prevention is associated with some complications, such as skin trouble or compartment syndrome.
Enoxaparin or fondaparinux is usually used for prevention of VTE after joint replacement surgery. In spinal surgery, postoperative epidural hematoma is the common complication without the use of an anticoagulant. Postoperative administration of an anticoagulant is a good prevention method for VTE after surgery, but it may cause epidural hematoma after spinal surgery, so anticoagulant therapy for prevention of VTE can not be used in spinal surgery.
Epidural catheterization after surgery is a useful method for decreasing the postoperative pain, but there is the risk of epidural bleeding especially on removal of the catheter. Preventive anticoagulant therapy should therefore be started after removal of the epidural catheter.
