Pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury: an Indian perspective

Abstract

Study design: Prospective randomized single blind study. Objectives: To find out the incidence of deep vein thrombosis (DVT) in Indian acute spinal cord injury (ASCI) subjects with and without pharmacological prophylaxis. Setting: Indian Spinal Injuries Centre. Methods: Seventy four ASCI subjects were randomly divided into two groups with 37 subjects each: group I received no antithrombotic prophylaxis, and only physical measures like compression stockings were employed for prophylaxis, whereas group II received antithrombotic prophylaxis with low-molecular weight heparin (LMWH) along with physical measures as in group I. DVT was monitored through daily clinical assessment and doppler venous ultrasonography at 2 weeks. Results: Out of 37 subjects in each group, eight (21.6%) developed DVT in group I and two (5.4%) in group II. The difference was significant (P-value ¼ 0.041). Six out of eight subjects who developed DVT in group I were asymptomatic. There was no incidence of significant DVT-related complications including pulmonary embolism in any of the subjects. Conclusions: There is a significant incidence of DVT in Indian subjects with ASCI but definitely less than what has been reported in western literature. Pharmacological prophylaxis (LMWH in this study) significantly (P ¼ 0.041) decreases the incidence of DVT in subjects with ASCI. As there was no difference in the incidence of symptomatic DVT or related complications, a larger study would be required to conclude definitely on the role of pharmacological prophylaxis in the Indian population.

Challenges in comprehensive management of spinal cord injury in India and in the Asian Spinal Cord network region: findings of a survey of experts, patients and consumers

“…4,[12][13][14] Institutional transfers Studies have also established the importance of minimizing institutional transfers before reaching the definitive institution in achieving an optimal outcome. 15 Our study revealed that this was far from optimal in the ASCoN region. Sixty-three percent of the patients reported that they reached a definitive institution after two or more institutional transfers.…”

Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.

“…They found DVT in 47% of the placebo group, 50% of the LDUH group, and 7% of the group that received the combination of FNS and LDUH (p < 0.05). Halim et al reported DVT in 22% of thirty-seven SCI patients given GCSs and in 5% of thirty-seven patients who received enoxaparin 40 mg once daily plus GCSs (Halim, 2014).…”

“…However, an age effect was not observed in large study of more than 12,000 SCI patients from California (Godat, 2015). ■ Complete versus incomplete injuries: The risks of VTE are greater with motor complete (AIS A) compared with incomplete (AIS B, C, or D) injuries (Aito, 2003;Halim, 2014;Matsumoto, 2015). ■ Concomitant lower-extremity fractures:…”

“…In a systemic review of nineteen randomized clinical trials, Sachdeva et al concluded that GCSs are effective in diminishing the risk of DVT in hospitalized patients (Sachdeva, 2014). However, GCSs have repeatedly been shown to provide relatively poor protection against DVT (Lacut, 2005;Halim, 2014), and they may produce injury to the skin as seen in patients with SCI or ischemic stroke (CLOTS, 2009;Ong, 2011). In a randomized trial among seventy-four SCI patients, GCSs were much less efficacious than LMWH, with DVT rates of 22% and 5%, respectively (Halim, 2014).…”

“…However, GCSs have repeatedly been shown to provide relatively poor protection against DVT (Lacut, 2005;Halim, 2014), and they may produce injury to the skin as seen in patients with SCI or ischemic stroke (CLOTS, 2009;Ong, 2011). In a randomized trial among seventy-four SCI patients, GCSs were much less efficacious than LMWH, with DVT rates of 22% and 5%, respectively (Halim, 2014). There is also uncertainty about the relative benefits of calflength versus thigh-length GCSs in any patient group (Sajid, 2006).…”