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Bilateral pulmonary emboli associated with intraoperative use of thrombin-based hemostatic matrix following lumbar spine interbody fusion.

Publication ,  Journal Article
Wei, Z; Elder, BD; Goodwin, CR; Witham, TF
Published in: J Clin Neurosci
September 2015

Here we describe a patient with bilateral pulmonary emboli (PE) associated with thrombin-based hemostatic matrix (TBHM) use in the setting of a possible venous injury during transforaminal lumbar interbody fusion in the treatment of degenerative spondylolisthesis at L4-5. TBHM products are gelatin granules mixed with human or bovine thrombin. They have been used in a wide variety of surgical procedures to facilitate local hemostasis though their use is not without complications. This is the first reported patient, to our knowledge, with a TBHM-related PE following spinal fusion. As TBHM is a widely used intraoperative hemostatic agent, surgeons should be aware of the risk of TBHM-associated PE, particularly when there is the potential for intravascular injection or dissemination. While our experience indicates that common pharmacological prophylaxis such as subcutaneous heparin is likely ineffective in reducing occurrence of PE in the setting of TBHM use, the PE was successfully treated with standard systemic anticoagulation. The authors would also add that when iliac injury is encountered during discectomy or interbody fusion through a posterior approach, use of TBHM may be a life-saving technique. Postoperatively, vascular surgery consultation is recommended and consideration should be given to systemic anticoagulation.

Duke Scholars

Published In

J Clin Neurosci

DOI

EISSN

1532-2653

Publication Date

September 2015

Volume

22

Issue

9

Start / End Page

1502 / 1505

Location

Scotland

Related Subject Headings

  • Thrombin
  • Spondylolisthesis
  • Spinal Fusion
  • Retrospective Studies
  • Pulmonary Embolism
  • Neurology & Neurosurgery
  • Lumbar Vertebrae
  • Iliac Artery
  • Humans
  • Hemostatics
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wei, Z., Elder, B. D., Goodwin, C. R., & Witham, T. F. (2015). Bilateral pulmonary emboli associated with intraoperative use of thrombin-based hemostatic matrix following lumbar spine interbody fusion. J Clin Neurosci, 22(9), 1502–1505. https://doi.org/10.1016/j.jocn.2015.03.012
Wei, Zhikui, Benjamin D. Elder, C Rory Goodwin, and Timothy F. Witham. “Bilateral pulmonary emboli associated with intraoperative use of thrombin-based hemostatic matrix following lumbar spine interbody fusion.J Clin Neurosci 22, no. 9 (September 2015): 1502–5. https://doi.org/10.1016/j.jocn.2015.03.012.
Wei, Zhikui, et al. “Bilateral pulmonary emboli associated with intraoperative use of thrombin-based hemostatic matrix following lumbar spine interbody fusion.J Clin Neurosci, vol. 22, no. 9, Sept. 2015, pp. 1502–05. Pubmed, doi:10.1016/j.jocn.2015.03.012.
Journal cover image

Published In

J Clin Neurosci

DOI

EISSN

1532-2653

Publication Date

September 2015

Volume

22

Issue

9

Start / End Page

1502 / 1505

Location

Scotland

Related Subject Headings

  • Thrombin
  • Spondylolisthesis
  • Spinal Fusion
  • Retrospective Studies
  • Pulmonary Embolism
  • Neurology & Neurosurgery
  • Lumbar Vertebrae
  • Iliac Artery
  • Humans
  • Hemostatics