Thrombophilic Abnormalities in Patients With or Without Pulmonary Embolism Following Elective Spinal Surgery

Suhel Kotwal, MD
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY

Satoshi Kawaguchi, MD
Department of Orthopedic Surgery, Sapporo Medical University, Sapporo, Japan

Alexander P. Hughes, MD
Assistant Attending Orthopedic Surgeon

Frank P. Cammisa Jr., MD
Chief of the Spine Service, Hospital for Special Surgery
Associate Professor of Surgery (Orthopaedics), Weill Cornell Medical College

Kai Zhang, MD
Weill Cornell College of Medicine, New York, NY


Eduardo A. Salvati, MD

Eduardo A. Salvati, MD

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Clinical Professor of Surgery (Orthopaedics), Hospital for Special Surgery

Federico P. Girardi, MD

Federico P. Girardi, MD

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Orthopaedic Surgery, Weill Cornell Medical College
Associate Scientist, Research Division, Hospital for Special Surgery

Abstract

Background

Significance of the thrombophilic abnormalities in development of venous thromboembolism (VTE) has been studies with total hip arthroplasty and acute traumatic spinal cord injury. However, their role as risk factors for VTE in elective spinal surgery remains to be determined.

Questions/Purposes

To determine the role of thrombophilic abnormalities in the development of pulmonary embolism (PE) following elective spine surgery.

Methods

Case and control groups were created in patients who had undergone elective spinal surgery for degenerative conditions. The PE group comprised 12 patients whose post-operative course was complicated by development of PE. The control group included 12 patients with an uneventful post-operative course. Demographic data including age, gender and surgical procedures were matched between the PE group and the control group. Both groups were evaluated for thrombophilic and hypofibrinolytic risk factors at 3 months post-operatively or later. Blood tests were performed to measure fasting serum homocysteine, antithrombin III, and protein C. Molecular genetic testing was conducted for detection of the plasminogen activator inhibitor-1 4G/4G, and prothrombin 3 UTR gene mutations.

Results

Heterozygous mutation (G20201A) of prothrombin was detected in two patients (16.7%) in the PE group, whereas no such mutation was noted in the control group. Plasminogen activator inhibitor-1 4G/4G homozygous mutation was seen in three in the PE group and two in the control group. Of homocysteine, antithrombin III and protein C, only one patient in each group showed abnormal levels of homocysteine. In total, there half of the patients in the PE group had at least one thrombophilic abnormality, whereas three (25%) patients showed such abnormality in the control group.

Conclusion

These findings suggest the involvement of thrombophilic abnormalities, especially the heterozygous G20201A mutation, in the development of PE in patients undergoing elective spinal surgery.

This article appears in HSS Journal: Volume 9, Number 1.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

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