The bleeding risk of low-molecular-weight heparin bridging therapy in patients receiving preoperative oral antithrombotic drugs during spinal fusion surgery.

PURPOSE: To evaluate whether preoperative oral antithrombotic therapy increases the perioperative bleeding tendency in patients undergoing spinal fusion with low-molecular-weight heparin (LMWH) bridging, and to compare their bleeding risk with that of a general surgical cohort.

METHODS

Patients undergoing spinal fusion (2019-2024) at two centers were categorized into three groups: (1) Oral Antithrombotics group (history of preoperative antithrombotic use with LMWH bridging), (2) No Oral Antithrombotics group (no preoperative antithrombotic history, receiving perioperative LMWH prophylaxis), and (3) Blank group (a 1:1 matched cohort without preoperative antithrombotic history or perioperative LMWH prophylaxis).

RESULTS

The Oral Antithrombotics group exhibited significantly higher intraoperative blood loss, increased transfusion rates, and longer hospital stays compared to the Blank group (p < 0.05). In the lumbar surgery subgroup, the Oral Antithrombotics group showed higher intraoperative and overt blood loss compared to the No Oral Antithrombotics group (p < 0.05), whereas no such differences were observed in cervical surgery.

CONCLUSION

While preoperative oral antithrombotic therapy with LMWH bridging does not raise the risk of severe bleeding events after spinal fusion, it correlates with an enhanced perioperative bleeding tendency, especially in lumbar fusion procedures.