Safety of Antiplatelet Therapy Continuation During Single-Level Anterior Cervical Decompression and Fusion: A Retrospective Observational Study

Abstract

This study aimed to investigate whether continuation of antiplatelet therapy during single-level anterior cervical decompression and fusion (ACDF) is associated with increased intraoperative blood loss or perioperative complications.

We retrospectively reviewed 43 patients who underwent single-level ACDF at our institution between January 2023 and August 2025. Patients were stratified into two groups: those who continued antiplatelet medication perioperatively (AP+ group; n = 3) and those who were not taking or had discontinued antiplatelet medication (AP− group; n = 40). The primary endpoint was intraoperative blood loss. Secondary endpoints included operative duration, postoperative epidural hematoma, length of hospital stay, and modified Rankin Scale score changes. Safety endpoints included perioperative cardiovascular events.

Continuous variables were expressed as median (interquartile range) and compared descriptively, including the Hodges–Lehmann estimate of median difference with 95% confidence interval (CI), given the small size of the AP+ group; the Mann–Whitney U test was used for completeness but is underpowered. Categorical variables were analyzed using Fisher's exact test and Pearson's chi-square test. Statistical significance was set at p <0.05.

Median intraoperative blood loss was 15 mL (range 5–20) in the AP+ group and 12.5 mL (range 0–100) in the AP− group (Hodges–Lehmann median difference: −5.0 mL, 95% CI: −15 to 10 mL; p = 0.702). No significant differences were observed in operative duration (120 vs. 127 minutes; Hodges–Lehmann difference: −24.0 minutes, 95% CI: −79 to 19 minutes, p = 0.321) or hospital stay (22 vs. 13.5 days; Hodges–Lehmann difference: 9.5 days, 95% CI: −6 to 168 days, p = 0.115). No postoperative cervical epidural hematoma requiring surgical intervention occurred in either group. No perioperative cardiovascular events were recorded.

No increase in intraoperative blood loss or perioperative complications was observed with continuation of antiplatelet therapy in patients undergoing single-level ACDF. With only three patients in the AP+ group, the study is underpowered, and these results should not be interpreted as demonstrating safety. Although the small sample size precludes definitive conclusions, these preliminary findings provide a basis for larger, prospective studies to evaluate the safety of antiplatelet continuation in this patient population.