Enoxaparin for prophylaxis of thromboembolism in spinal cord injury: A preliminary report on the experience with 107 patients

Harris, Sandra; Chen, David; Bell, Hollis K.; Yarkony, Gary M.; Meyer, Paul

doi:10.1016/0003-9993(94)90896-6

Cited by 5 publications

(10 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12 With our aggressive LMWH administration, the data show a 6.1% DVT and a 4.1% PE rate, with an absence of bleeding events. Although our thromboembolic event rate is higher than in the retrospective study by Harris et al, 9 it is on the lower end of the commonly reported DVT rates in the literature. Our study's main significance comes with the absence of adverse bleeding events.…”

Section: Discussioncontrasting

confidence: 78%

See 1 more Smart Citation

Safety and effectiveness of early chemical deep venous thrombosis prophylaxis after spinal cord injury: pilot prospective data

DiGiorgio

Tsolinas²,

Alazzeh

et al. 2017

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVESpinal cord injuries (SCIs) occur in approximately 17,000 people in the US each year. The average length of hospital stay is 11 days, and deep venous thrombosis (DVT) rates as high as 65% are reported in these patients. There is no consensus on the appropriate timing of chemical DVT prophylaxis for this critically injured patient cohort. The object of this study was to determine if low-molecular-weight heparin (LMWH) was safe and effective if given within 24 hours of SCI.METHODSThe Transforming Research and Clinical Knowledge in SCIs study is a prospective observational study conducted by the UCSF Brain and Spinal Injury Center. Protocol at this center includes administration of LMWH within 24 hours of SCI. Data were retrospectively reviewed to determine DVT rate, pulmonary embolism (PE) rate, and hemorrhagic complications.RESULTSForty-nine patients were enrolled in the study. There were 3 DVTs (6.1%), 2 PEs (4.1%), and no hemorrhagic complications. Regression modeling did not find an association between DVT and/or PE and age, American Spinal Injury Association grade, sex, race, or having undergone a neurosurgical procedure.CONCLUSIONSA standardized protocol in which LMWH is given to patients with SCI within 24 hours of injury is effective in keeping venous thromboembolism at the lower end of the reported range, and is safe, with a zero rate of adverse bleeding events.

show abstract

Section: Discussioncontrasting

confidence: 78%

“…There was no evidence of DVT; however, there were 3 episodes of bleeding complications that were attributed to the therapy. 9 The recommended range of time to wait before starting chemical DVT prophylaxis varies widely. Ploumis et al recommend starting LMWH within 2 weeks, 14 whereas Christie et al recommend 72 hours.…”

Section: Discussionmentioning

confidence: 99%

Safety and effectiveness of early chemical deep venous thrombosis prophylaxis after spinal cord injury: pilot prospective data

DiGiorgio

Tsolinas²,

Alazzeh

et al. 2017

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…9 Notably, long-term mortality has not decreased in this population over the past 3 decades. 10 Anticoagulation with heparinoid chemoprophylaxis has been utilized as an effective strategy to safely decrease VTE in SCI patients [11][12][13] with both unfractionated heparin (UFH) [14][15][16] and low molecular weight heparin (LMWH) 8,17 being most studied, and at various doses. 18 Mechanical prophylaxis has been shown to augment the effect of chemical prophylaxis, 16,19,20 but prophylaxis with inferior vena cava (IVC) filters has been associated with higher rates of deep vein thrombosis (DVT) in acute SCI patients.…”

Section: Introductionmentioning

confidence: 99%

“…There is some evidence in the literature that chemoprophylaxis closer to the time of injury is associated with lower rates of DVT and VTE. 11,16,17,23,24,[35][36][37][38] Several systematic reviews have subsequently recommended for the strategy of chemoprophylaxis within 72 hours of SCI 13,19,32 including guidelines published by the American Association of Neurological Surgeons/Congress of Neurological Surgeons in 2013, which gave a level II recommendation. 19,35 The purpose of this study is to investigate the effectiveness and safety of initiating early VTE chemoprophylaxis within 24 hours of SCI in a surgical cohort by comparing the outcomes of individuals who received chemoprophylaxis within 24 hours of injury to those between 24 and 72 hours, and after 72 hours.…”

Section: Introductionmentioning

confidence: 99%

Venous Thromboembolism Chemoprophylaxis Within 24 Hours of Surgery for Spinal Cord Injury: Is It Safe and Effective?

Ahlquist¹,

Park²,

Kelley³

et al. 2020

Neurospine

View full text Add to dashboard Cite

Objective: Current guidelines recommend initiation of venous thromboembolism (VTE) chemoprophylaxis within 72 hours of spinal cord injury (SCI). This study investigated the safety and efficacy of chemoprophylaxis within 24 hours of surgery for SCI. Methods: A retrospective review of 97 consecutive patients who underwent surgery for acute traumatic SCI at a single level 1 trauma center from 2013-2018 was performed. VTE/ postoperative bleeding rates during hospitalization, demographics, medical/surgical complications, drain output, length of stay, and disposition were obtained. Chi-square with odds ratios (ORs), 1-way analysis of variance, and logistic regression were performed to establish significant differences between groups. Results: Seventy-nine patients were included, 49 received chemoprophylaxis within 24 hours and 20 within 24-72 hours. Cohort characteristics included an average age of 51.8 years, 77.2% male, 62.0% cervical, and 35.4% thoracic SCIs. Using the American Spinal Injury Association Impairment Scale (AIS), 39.2% were AIS-A injuries, 19.0% AIS-B, 25.3% AIS-C, and 16.5% AIS-D. Unfractionated heparin was administered in 88.6% of patients and 11.4% received low molecular weight heparin. Chemoprophylaxis within 24 hours of surgery was associated with a lower rate of VTE (6.1% vs. 35.0%; OR, 0.121; 95% confidence interval [CI], 0.027-0.535) and deep vein thrombosis (4.1% vs. 30.0%; OR, 0.099; 95% CI, 0.018-0.548) versus 24-72 hours. Pulmonary embolism rates were not significantly different (6.1% vs. 5.0%, p = 1.0). There were no postoperative bleeding complications and no significant difference in drain output between cohorts. Conclusion: Early VTE chemoprophylaxis is effective with lower VTE rates when initiated within 24 hours of surgery for SCI and is safe with no observed postoperative bleeding complications.

show abstract

“…Green, et al [121] have reported an event rate (bleeding and DVT) of 14.1% with tinzaparin which compares favorably with a 31% rate using fixed-dose UFH [ 120]. A retrospective study demonstrated similar effectiveness with enoxaparin [122]. Confirmation of efficacy and safety by prospective, controlled trials is needed.…”

Section: Traumamentioning

confidence: 99%

Low molecular weight heparin: An evaluation of current and potential clinical utility in surgery

Davies¹,

Coady²,

Hammond³

et al. 1999

Int J Angiol

View full text Add to dashboard Cite

Enoxaparin for prophylaxis of thromboembolism in spinal cord injury: A preliminary report on the experience with 107 patients

Cited by 5 publications

References 0 publications

Safety and effectiveness of early chemical deep venous thrombosis prophylaxis after spinal cord injury: pilot prospective data

Safety and effectiveness of early chemical deep venous thrombosis prophylaxis after spinal cord injury: pilot prospective data

Venous Thromboembolism Chemoprophylaxis Within 24 Hours of Surgery for Spinal Cord Injury: Is It Safe and Effective?

Low molecular weight heparin: An evaluation of current and potential clinical utility in surgery

Contact Info

Product

Resources

About