The Influence of Preoperative Antiplatelet and Anticoagulant Agents on Outcomes in Patients Undergoing Anterior Cervical Discectomy

Abstract Background: Anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) are surgical procedures performed to treat degenerative conditions of the cervical spine. Anticoagulants and antiplatelets are medications that are commonly used to prevent the formation of blood clots and are often taken by patients before surgery to reduce the risk of thrombotic complications. However, the use of these medications can also increase the risk of bleeding during and after surgery. Aim: There is limited information about the risk of antiplatelet and anticoagulant usage for patients undergoing ACDF and CDR. Consequently, there is no obvious consensus regarding the duration or necessity of discontinuing these medications during the perioperative period. The purpose of this paper is to review the current evidence to see the clinical outcomes of the discontinuation or continuation of antithrombotic agents before ACDF and CDR at Taipei Medical University Hospital. Methods: The retrospective observational study is done in Taipei Medical University Hospital. A total of 348 patients undergoing CDR or ACDF between January 2021 and December 2022 are enrolled. The patients are divided into two groups based on the discontinuation of their antiplatelet or anticoagulant therapy (d-APT or d-ACT) before an operation. The criteria of d-APT patients in this group are to stop taking their antiplatelet medication for a minimum of 4 days before the operation and d-ACT patients in this group are to discontinue their anticoagulant medication for at least 3 days before the operation. The analysis of continuous variables is conducted using the Mann–Whitney U test. For the analysis of categorical variables, the Chi-square test or Fisher’s exact test is used. P <0.05 is considered statistically significant. Results: A total of 348 patients have undergone CDR or ACDF between January 2021 and December 2022. Twenty-seven patients have received APTACT preoperatively. Twenty-one patients have undergone surgery under the continuation of antiplatelet or anticoagulant (c-APT-ACT), and five patients have undergone surgery under d-APT-ACT before surgery. The percentage of patients with diabetes mellitus in the c-APT-ACT group is significantly greater than that in the d-APT-ACT group (12/21 [57.1%] and 0/5 [0%], P = 0.043). There are no significant differences in age, sex, body mass index, smoking habits, hypertension, dyslipidemia, chronic kidney disease, cancer, hemoglobin level, platelet count, international normalized ratio, and activated partial thromboplastin time. There are no significant differences in indication of APT and ACT including coronary artery disease, cerebrovascular accident (CVA), and atrial fibrillation. There are no significant differences in intraoperative blood loss (<10c.c is 4 [80%] in d-APT-ACT and 13 [61.9%] in c-APT-ACT, P = 0.628; between 30 and 69c.c is 0 in d-APT-ACT and 5 [23.8%] in c-APT-ACT, P = 0.545; and between 70 and 99c.c is 0 in d-APT-ACT and 2 [9.5%] in c-APT-ACT, P = 0.354). There are no patients receiving intraoperative blood transfusion, and no acute myocardial infarction (AMI)/CVA within 1 year after surgery nor use of postoperative drainage in both groups. Length of postoperative stay is 5.6 days in d-APT-ACT and 3.76 days in c-APT-ACT ( P = 0.493). Conclusion: According to our results, for patients with APT or ACT usage receiving ACDF or CDR, continuing antiplatelet or anticoagulant therapy has a minimal difference in surgical outcome and length of postoperative stay difference, so continuing antiplatelet or anticoagulant therapy should be considered in selected cases.