Anticoagulation therapy after surgical treatment of spinal dural arteriovenous fistula. Effectiveness and long-term outcome analysis.

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Anticoagulation therapy after surgical treatment of spinal dural arteriovenous fistula. Effectiveness and long-term outcome analysis.

World Neurosurg. 2018 Mar 14;:

Authors: Jablawi F, Schubert GA, Hans FJ, Mull M

Abstract
OBJECT: Effectiveness and safety of anticoagulation therapy (AC) after treatment of spinal dural arteriovenous fistula (sdAVF) are still inadequately discussed in the literature and are the aim of this study.
METHODS: We retrospectively analyzed our medical database for sdAVF patients treated in our institution between 2006 and 2016. Neurological status at time of admission, discharge and last follow-up was assessed via Aminoff-Logue disability score. Patient cohorts were dichotomized as group A: postoperative effective heparinization, and group B: routine thromboembolic prophylaxis with low-dose heparin.
RESULTS: 53 patients were included in this analysis. In group A (n=11) no acute deterioration was reported. In group B (n=42), four patients developed acute postoperative deterioration; affective heparinization was initiated in all these four patients resulting in complete neurological recovery within the inpatients stay. However, the incidence of postoperative deterioration did not reach statistical significance between treatment groups (p=0.57). Data of 40 patients were available for long-term analysis (mean 53.4±36 months). Neurological status did not differ significantly between both groups at time of admission (p=0.093), of discharge (p=0.723) and of last follow-up (p=0.222).
CONCLUSION: Acute postoperative deterioration in sdAVF patients is a clinically relevant complication and was present in 7.5% of patients in our series. While routine effective anticoagulation did not decrease the rate of acute deterioration significantly, our findings imply that effective anticoagulation in cases of acute postoperative deterioration might be a safe and efficient treatment option.

PMID: 29550595 [PubMed - as supplied by publisher]

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