Letter to the editor regarding chemical prophylaxis and venous thromboembolism following elective spinal surgery - a systematic review and meta-analysis

Sep 29, 2026

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North American Spine Society Journal (NASSJ) letters to the editor critically discuss a systematic review and meta-analysis on chemical thromboprophylaxis after elective spinal surgery. The letter raises a discrepancy about exclusion of known cancer cases and notes missing tumor-surgery details in the study’s exclusion criteria, contrasting it with specific postoperative epidural hematoma cases reported by Cunningham et al. Additional concerns include grouping DVT and PE under venous thromboembolism despite different pooled incidences and the lack of direct references to surgical types across included studies.

LanguageEnglish

CategoryHealthcare

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Pages2

Reading Time5 min

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Letters to the Editor

Chemical prophylaxis and venous thromboembolism after elective spinal surgery

Concerns about cancer exclusions and tumor surgery reporting

DVT vs PE under VTE and differences in pooled incidence

Lack of direct references to types of surgeries across studies

References

North American Spine Society Journal (NASSJ) 24 (2025) 100311 Contents lists available at ScienceDirect North American Spine Society Journal (NASSJ) journal [homepage:](homepage: www.elsevier.com/locate/xnsj)[ www.elsevier.com/locate/xnsj](homepage: www.elsevier.com/locate/xnsj) Letters to the Editor Letter to the editor regarding chemical prophylaxis and venous thromboembolism following elective spinal surgery: a systematic review and meta-analysis I found the article by Rahmani et [al. to](al. to) be highly intriguing during my reading [1]. In this valuable systematic review, 19 articles were analyzed to establish the general occurrence rates of deep venous thrombosis (DVT), pulmonary embolism (PE), and spinal epidural hematomas (SEH) following elective spine surgery and to assess the impact ofchemical thromboprophylaxis on these rates. We want to line out two concerns. In the abstract of the present study, it is clearly mentioned that the known cases of cancer were excluded. Also, in the Baseline patient characteristics section of the results, it is noted that Indications for spine surgeries among included studies varied from degenerative disc disease to spinal canal stenosis and disc herniation, and there is no mention of tumor surgeries. The absence of tumor surgeries in this study’s section on exclusion criteria creates a discrepancy with the information presented in these sentences. However, in Table 2 of the study conducted by Cunningham et al., which summarizes features of postoperative spinal epidural hematoma cases, it is obviously stated that patient number 2 and patient number 16 underwent surgeries for excision ofT1/3 intradural tumor and L3/4 decompression for intradural tumor respectively [2]. In six studies, encompassing the studies revealed by Pirkle et al., Fawi et al., Hamidi et al., Macki et al., McLynn et al., Cloney et al., Thota et al., and Zervos et al., the exclusion of patients with tumors is precisely outlined as one of the exclusion criteria [3–10]. Also, in another study by Weber et al., no spinal tumor was among the elective spine surgery cases [11]. On the other hand, surgeries for tumors were not mentioned in the exclusion criteria of nine other studies [12–20]. Additionally, upon conducting a thorough literature review, we identiﬁed some studies that showed spinal tumors and their surgeries carry a high risk of hemorrhage and VTE [21–23]. In general, it should be highlighted that the lack of direct separate references to the types of surgeries performed in each of the included studies is the main drawback of this study. Another probable weakness that needs to be noticed is the consideration of DVT and PE under the title of venous thromboembolism (VTE). Given the diﬀerence between the pooled incidence of DVT (3.3) and PE (0.4), this study would beneﬁt from an isolated analysis of these two complications. References [1] Rahmani R, Eaddy S, Stegelmann SD, Skrobot G, Andreshak T. Chemical prophylaxis and venous thromboembolism following elective spinal surgery: a systematic review and meta-analysis. North Am Spine Soc J 2023:100295. [2] Cunningham JE, Swamy G, Thomas KC. Does preoperative DVT chemoprophylaxis in spinal surgery aﬀect the incidence of thromboembolic complications and spinal epidural hematomas? Clin Spine Surg 2011;24(4):E31–EE4. [3] Cloney MB, Hopkins B, Dhillon E, El Tecle N, Koski TR, Dahdaleh NS. Chemoprophylactic anticoagulation following lumbar surgery signiﬁcantly reduces thromboembolic events after instrumented fusions, not decompressions. Spine 2023;48(3):172–9. [4] Fawi H, Saba K, Cunningham A, et al. Venous thromboembolism in adult elective spinal surgery: a tertiary centre review of 2181 patients. Bone Joint J 2017;99(9):1204–9. [5] Hamidi S, Riazi M. Incidence of venous thromboembolic complications in instrumental spinal surgeries with preoperative chemoprophylaxis. J Korean Neurosurg Soc 2015;57(2):114–18. [6] Macki M, Haddad Y, Surya

FAQs

What concerns does the letter raise about the systematic review’s cancer exclusion?

The letter notes that cancer cases are said to be excluded in the abstract, but tumor surgeries are not reflected in the exclusion criteria discussion while tumor-related operations are described elsewhere in the literature.

How does the letter address the reporting of tumor surgeries in included studies?

It highlights that the baseline characteristics and exclusion criteria in the systematic review do not mention tumor surgeries, creating a discrepancy, and it points to specific tumor-related procedures in another study’s table.

Why does the letter recommend analyzing DVT and PE separately?

The letter argues that treating DVT and PE as the same outcome under VTE overlooks their different pooled incidences, and it suggests isolated analysis for clearer interpretation.

Sep 29, 2026

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