Association Between Early Chemoprophylaxis versus No Chemoprophylaxis and Risk of Venous Thromboembolism and Bleeding Complications after Same-Day Spine Surgery for Central Cord Syndrome: A Retrospective Cohort Analysis

Study Design Retrospective cohort study Objectives To examine whether early chemoprophylaxis, compared with no chemoprophylaxis, is associated with a reduced risk of venous thromboembolism (VTE) and bleeding complications after spine surgery for acute central cord syndrome (CCS). Setting Multi-site academic centers Methods This pre-registered study using the TriNetX database included adults who underwent primary cervical spine surgery the same day they sustained a CCS. After excluding those with very high VTE risk or prior VTE, we divided participants into cohorts depending on the administration of chemoprophylaxis (heparin or enoxaparin; chemoprophylaxis cohort) versus no chemoprophylaxis (no chemoprophylaxis cohort) within the first three days after surgery. Outcomes through three months included the incidence and risk ratio (RR) of VTE (primary), pulmonary embolism (PE), deep venous thrombosis (DVT), and deceased status. Cohorts were propensity matched according to key risk factors. Results There were 2,417 participants per matched cohort with high follow-up retention (98%). Between cohorts, there was no statistically significant or clinically meaningful difference in the risk of VTE (p=0.375) over three months’ follow-up. Furthermore, there was no statistically significant difference in the risk of PE (p=0.762) or DVT (p=0.384). We were unable to assess the risk of epidural hematoma or severe postoperative bleeding as both outcomes were rare. Conclusion Early postoperative chemoprophylaxis was not associated with reduced VTE risk compared with no chemoprophylaxis after spine surgery for acute CCS in adults. These findings do not provide evidence supporting routine chemoprophylaxis use in CCS participants after surgery. However, clinical decisions should remain individualized.