頚椎椎弓形成術における低用量アスピリン継続下手術の安全性の検討

抄録

  Purpose : Antiplatelet drugs reduce the risk of ischemic events but increase the risk of bleeding. A decision to discontinue these drugs can be made only after weighing the risk of bleeding against the risk of thromboembolic ischemic events. Here, we report two cases of cerebral infarctions in patients who underwent cervical and lumbar surgeries after discontinuation of low-dose aspirin treatment during the period starting in October 2006. Because of these events, we abandoned practice of suspending low-dose aspirin treatment perioperatively in all cases of spinal surgery. Since April 2010, all spinal surgeries have been carried out without discontinuing low-dose aspirin. Here, we report the safety of ongoing low-dose aspirin treatments in patients undergoing cervical laminoplasty.

  Materials and Methods : Of 301 patients who underwent cervical laminoplasty performed by a single surgeon from October 2006 to March 2013, 45 patients had received low-dose aspirin treatment. These patients were divided into groups as follows : 12 patients with ongoing low-dose aspirin treatment, 17 patients with brief discontinuation of aspirin (treatment discontinued for 1-2 days), and 16 with perioperative discontinuation (treatment discontinued for 3-9 days). We compared the results of the three groups with respect to the amount of intraoperative bleeding, the volume of postoperative drainage, and the incidence of ischemic or hemorrhagic complications.

  Results : The amount of intraoperative bleeding, the volume of postoperative drainage, and their sum, presented as mean±S. D., were respectively 72.5±44.2, 160.4±80.5, and 232.9±100.3 ml in the perioperative discontinuation group ; 79.4±84.3, 188.8±68.8, and 268.2±130.8 ml in the brief discontinuation group ; and 129.6±181.6, 210.9±110.7, and 340.5±201.8 ml in the ongoing treatment group. There were no statistically significant inter-group differences in the results. Two cerebral infarctions occurred 3 days after surgery in the perioperative discontinuation and no administration treatment groups. The ongoing treatment group tended to have higher blood loss, but none of the patients developed symptomatic epidural hematoma, nor did any patient require blood transfusions in any of the groups.

  Conclusion : These results are useful in the management of patients at an increased risk of thromboembolic complications if antiplatelet drugs are stopped. Further study with larger number of cases is needed to validate our findings.