Mechanical plus pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury

Gj, Merli; Crabbe, Sarah J.; Doyle, Louise; Jf, Ditunno; Gj, Herbision

doi:10.1038/sc.1992.115

Cited by 45 publications

(23 citation statements)

References 11 publications

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“…Of the 9 selected original articles, there were 3 randomized clinical trials and 6 case series that screened for asymptomatic DVT among individuals who underwent drug thromboprophylaxis during the acute stage after SCI (Table 1). 17,[22][23][24][25]38,40,53,70 Additionally, 2 systematic reviews from searches in the MEDLINE, EMBASE, and COCHRANE databases were considered as eligible to be included in our comprehensive review (Table 2). 28,32 …”

Section: Resultsmentioning

confidence: 99%

Role of Screening Tests for Deep Venous Thrombosis in Asymptomatic Adults With Acute Spinal Cord Injury

Furlan

Fehlings

2007

Spine

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There is insufficient evidence to support (or refute) a recommendation for routine screening for DVT in adults with acute traumatic SCI under thromboprophylaxis. However, there is level II-2 evidence that screening could detect asymptomatic DVT in 22.7% of those individuals. Although additional investigation is needed, we hypothesize that weekly screening for DVT during the first 13 weeks post-SCI could detect most of the asymptomatic DVT events in this patient population. D-Dimer, ultrasound, and MR venography could be considered as potentially useful screening tests for DVT in the SCI population in future research studies.

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Section: Resultsmentioning

confidence: 99%

Role of Screening Tests for Deep Venous Thrombosis in Asymptomatic Adults With Acute Spinal Cord Injury

Furlan

Fehlings

2007

Spine

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“…11 The addition of mechanical thromboprophylactic measures enhanced the protective e ect. 12 A number of authors have reported on the advantages and e cacy of LMWH since the early 90s. Green used LMWH in a dose of 3500 anti Xa units and reported no VT episodes in 20 patients.…”

Section: Discussionmentioning

confidence: 99%

A comparison of heparin/warfarin and enoxaparin thromboprophylaxis in spinal cord injury: the Sheffield experience

et al. 2002

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Objectives: To compare the safety and e ectiveness of two di erent thromboprophylactic protocols in the management of patients with spinal cord injury ± one using heparin/warfarin and the other using enoxaparin. Study design: Retrospective. Setting: Princess Royal Spinal Injuries Unit, She eld, UK. Methods: Retrospective review of two cohorts of patients with acute spinal injury admitted to a supra-regional spinal injuries centre and treated with di erent pharmacological agents. One group received heparin/warfarin in combination with antiembolism stockings and mechanical measures for thromboprophylaxis whereas the second group received enoxaparin in combination with the other measures. Patients who developed clinical symptoms suggestive of deep vein thrombosis or pulmonary embolism were investigated as appropriate. Results: Four of the 101 patients on heparin/warfarin developed symptoms of venous thromboembolism compared to 13 of the 72 who were on enoxaparin. Of the 13, three had been on 40 mg of enoxaparin daily and 10 on 20 mg enoxaparin daily. Six patients on enoxaparin and one patient on warfarin developed thromboembolic complications after they had been mobilised and the anticoagulant discontinued. Eight patients on warfarin prophylaxis and three patients on enoxaparin developed haemorrhagic complications necessitating cessation of therapy. Conclusion: This study suggests that the traditional protocol of warfarin/heparin for thromboprophylaxis in spinal cord injury patients remains a safer option than enoxaparin.

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“…As summarized in Table 2 heparin alone does not prevent DVT in the acute SCI subject, but is effective in combination with functional electrical stimulation or elastic stockings. 39,40 The effect of elastic stockings alone has not been tested.…”

Section: Diagnosismentioning

confidence: 99%

The prevalence of pulmonary embolism in chronically paralyzed subjects: a review of available evidence

Frisbie¹,

Sharma

2011

Spinal Cord

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Study design: Qualitative systematic review. Objectives: To examine the validity of the prevailing notion that pulmonary embolism (PE) is rare in the chronic spinal cord injury (SCI) population. Setting: USA. Methods: Review surveys of adult SCI subjects 42 months after injury in which PE has been looked for and its prevalence estimated. Results: A total of 16 surveys of chronic SCI subjects published between 1956 and 2009 offered data on PE prevalence. Two autopsy surveys, 178 subjects paralyzed 42 months, revealed no PE. Eleven surveys of the cause of death, 3193 subjects paralyzed 1-25 years, revealed PE in 2.1%. Two surveys of survivors of SCI, 5761 subjects paralyzed 1-25 years, revealed PE in 0.4%. Our survey of 112 subjects paralyzed 1-50 years before death, revealed PE in 21 (18.7%), based on autopsy, imaging, clinical and electrocardiographic evidence. In 7 (33%) of the 21 subjects with PE, pulmonary hypertension by transthoracic echocardiography was detected, indicating recurrent and/or unresolved PE. Conclusion: PE is not infrequent in the chronic SCI subject; but its presentation may be subclinical; and its apparent recurrence may lead to pulmonary hypertension.

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Mechanical plus pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury

Cited by 45 publications

References 11 publications

Role of Screening Tests for Deep Venous Thrombosis in Asymptomatic Adults With Acute Spinal Cord Injury

Role of Screening Tests for Deep Venous Thrombosis in Asymptomatic Adults With Acute Spinal Cord Injury

A comparison of heparin/warfarin and enoxaparin thromboprophylaxis in spinal cord injury: the Sheffield experience

The prevalence of pulmonary embolism in chronically paralyzed subjects: a review of available evidence

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