NEW FROM NASS:
Clinical Practice Guidelines and Appropriate Use Criteria for Antithrombotic Therapies
Antithrombotic management remains one of the most complex and consequential aspects of perioperative spine care. Clinicians must balance the risk of venous thromboembolism against the potential for bleeding complications, often with limited or mixed evidence. To help address these challenges, NASS has released a new Clinical Practice Guideline (CPG) and companion Appropriate Use Criteria (AUC) focused on antithrombotic therapies for adult patients undergoing spine surgery.
Together, the two documents are intended to support clinical decision-making across a wide range of real-world scenarios, offering evidence-based guidance where available and expert consensus where evidence is limited.
Key Takeaways from the Committees
Several high-level themes emerged from the CPG and AUC:
- Antithrombotic therapy was not rated as “rarely appropriate” in any of the evaluated scenarios, demonstrating its role in perioperative management.
- Timing of initiation plays a critical role in balancing thromboembolic and bleeding risks.
- More variability and clinical discretion are reflected in scenarios involving initiation within the first 24 hours after surgery, especially among lower-risk patients.
The antithrombotic CPG and AUC are intended to provide practical resources for spine care teams navigating complex perioperative decisions. By pairing evidence-based recommendations with structured expert consensus, the documents support consistency in care while respecting provider clinical judgement in individual cases.
Both resources are now available on the NASS website: