Anticoagulation Therapy After Surgical Treatment of Spinal Dural Arteriovenous Fistula. Effectiveness and Long-Term Outcome Analysis

Objective: Effectiveness and safety of anticoagulation therapy (AC) after treatment of spinal dural arteriovenous fistula (sdAVF) are still inadequately discussed in the literature and are addressed in this study.

Methods: We retrospectively analyzed our medical database for patients with sdAVF treated in our institution between 2006 and 2016. Neurologic status at time of admission, discharge, and last follow-up was assessed via Aminoff-Logue disability score. Patient cohorts were dichotomized as group A (postoperative therapeutic heparinization) and group B (routine thromboembolic prophylaxis with low-dose heparin).

Results: Fifty-three patients were included in this analysis. In group A (n = 11), no acute deterioration was reported. In group B (n = 42), 4 patients developed acute postoperative deterioration; therapeutic AC was initiated in all 4 patients resulting in complete neurologic recovery within the inpatient stay. However, the incidence of postoperative deterioration did not reach statistical significance between treatment groups (P = 0.57). Data of 40 patients were available for long-term analysis (mean, 53.4 ± 36 months). Neurologic status did not differ significantly between both groups at time of admission (P = 0.093), discharge (P = 0.723), and last follow-up (P = 0.222).

Conclusions: Acute postoperative deterioration in patients with sdAVF is a clinically relevant complication and was present in 7.5% of patients in our series. Although routine therapeutic AC did not decrease the rate of acute deterioration significantly, our findings imply that therapeutic AC in cases of acute postoperative deterioration might be a safe and efficient treatment option.