Prevention of thromboembolism in spinal cord injury: Role of low molecular weight heparin

Chen, David; Chmiel, Joan S.; Olsen, Norman H.; Berkowitz, Michael; Novick, Alan K.; Alleva, Joseph T.; Steinberg, David; Nussbaum, Steven B.; Tolotta, Maria; Weller, Katherine A.

doi:10.1016/0003-9993(94)90031-0

Cited by 80 publications

(61 citation statements)

References 8 publications

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“…3 In the present study there was no incidence of fatal pulmonary embolism although there were two (0.7%) cases of non fatal pulmonary embolism. One of these patients had a fractured pelvis and had already stopped enoxaparin.…”

Section: Discussioncontrasting

confidence: 46%

“…4,5 The use of low molecular weight heparins has increased recently. 1,3,4 The dierent forms of low molecular weight heparins are used in varying dosage and frequency 1,3 although experience in patients with spinal injuries is limited. Only one study could be found in the English literature regarding the use of enoxaparin in patients with spinal injuries.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The incidence of fatal pulmonary embolism has been reported to be 2.7% in the same patient population. 3 Suggested prophylactic measures include early mobilisation, mechanical compression devices, elastic hosiery, graduated pressure stockings, warfarin, unfractionated heparin, low molecular weight heparins and vena caval ®lters. 4,5 There has been recent increasing interest in using low molecular weight heparins including enoxaparin.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 There has been recent increasing interest in using low molecular weight heparins including enoxaparin. 1,3 We could ®nd only one study published in the English literature describing the use of this agent in patients with spinal injuries. 1 The present study was carried out to evaluate the clinical ecacy of enoxaparin used for thromboembolic prophylaxis in acute spinal injury patients with or without neurological de®cit.…”

Section: Introductionmentioning

confidence: 99%

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Prophylaxis of thromboembolism in spinal injuries–results of enoxaparin used in 276 patients

Deep

Jigajinni²,

McLean³

et al. 2001

Spinal Cord

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Objective: To evaluate the results of thromboembolic prophylaxis using enoxaparin in acute spinal injury patients. Background: Deep vein thrombosis and pulmonary embolism are major causes of morbidity and mortality in patients with acute spinal injuries. A wide range of thromboprophylactic measures have been proposed. The present study describes the outcome of a regime of enoxaparin and antithromboembolic stockings in acute spinal injuries irrespective of neurological damage. Setting: Scotland, UK. Methods: Eighteen-month retrospective review of acute spinal injury patients admitted to a national spinal injuries unit. A thromboembolic prophylactic regimen of early mobilisation, use of antithromboembolic stockings, and subcutaneous administration of enoxaparin 40 mg once a day until patients could be mobilised for more than 4 h per day, was used. Patients with clinical suspicion of deep venous thrombosis or pulmonary embolism were investigated as appropriate. Results: Out of 146 (53% of total) patients with spinal injuries with no neurological de®cit only one patient (0.4%) developed clinical evidence of pulmonary embolism and out of 130 (47% of total) with spinal cord injury two (0.7%) developed clinical evidence of deep venous thrombosis while still on enoxaparin. Four patients (1.5%) developed deep venous thrombosis and one (0.4%) pulmonary embolism after discontinuing enoxaparin. There were no fatal pulmonary emboli and one suspected intraspinal bleeding. Conclusions: The present study suggests that, in addition to physical and mechanical measures, low molecular weight heparin in the form of enoxaparin 40 mg administered once daily compares favourably with previous studies for thromboprophylaxis in acute spinal injuries. Spinal Cord (2001) 39, 88 ± 91

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prophylaxis of thromboembolism in spinal injuries–results of enoxaparin used in 276 patients

Deep

Jigajinni²,

McLean³

et al. 2001

Spinal Cord

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“…9 ± 11 This frequency of DVT decreases after 6 months, but the DVT is still apparent several months following the injury. 11 Venous stasis due to muscular hypotonia and prolonged immobility is associated with this high incidence of thrombosis. As endothelial reactivity is modulated by circulating blood¯ow and hydrostatic pressure, it was interesting to evaluate this reactivity in the lower limbs compared to the upper limbs in these patients whose spinal cord injury had occurred 1 to 6 months earlier and to compare to controls.…”

Section: Introductionmentioning

confidence: 99%

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury

et al. 1997

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Deep vein thrombosis (DVT) is a frequent event in patients with spinal cord injury, even with prophylactic anticoagulant therapy. Lower limb paralysis is a known major risk factor for venous thrombosis, supposedly due to the venostasis in relation with total immobility. The main goal of this study was to evaluate the endothelial response to anoxia to determine whether recovery of ®brinolytic potential occurs in patients subjected to forced bedrest because of a spinal cord injury and whether this recovery is related to the incidence and/or evolution of DVT. We evaluated vascular endothelium reactivity in the lower limbs no longer submitted to the hydrostatic pressure of the erected position in 15 patients with paraplegia or tetraplegia and in 10 normal volunteers after venous occlusion produced by the application of 10 cm Hg pressure to the lower limb for 15 min comparatively to the upper limb used as reference. Among the 15 patients, 10 whose spinal cord injury had occurred 1 to 6 months earlier were still receiving prophylactic anticoagulant therapy, whereas the ®ve other patients were not receiving prophylactic anticoagulants because the injury dated back 6 months or more. After venostasis, tissue plasminogen activator (tPA) increased signi®cantly in both patients and controls in the upper limb (tPA levels twofold and threefold respectively in controls and patients) but showed no signi®cant changes in the lower limb; prolonged immobility did not allow recovery in the lower limbs of a level of ®brinolytic responsiveness identical to that in the upper limbs. The plasminogen activator inhibitor (PAI 1 ) remained unchanged after anoxia, although wide interindividual variations were seen. Natural coagulation inhibitors and circulating blood stigmates of hypercoagulability were measured. None of the patients had abnormally low levels of coagulation inhibitors (ie, antithrombin III, protein C and protein S levels were normal). Seventy-®ve per cent of patients (prophylactically anticoagulated or not) had very high levels of ®brin degradation products (D. Dimer levels sevenfold to eightfold those of the controls), but all patients had normal levels of thrombinantithrombin complexes and prothrombin fragments 1+2. The permanence of the thrombotic process characterized by an increase in D. Dimer levels without recovery of ®brinolytic potential suggests a proposal for the patients an inde®nite antithrombotic treatment at curative doses.

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Deep Vein Thrombosis and Its Prevention in Critically Ill Adults

Attia¹,

Ray²,

Cook³

et al. 2001

Arch Intern Med

322

165

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Prevention of thromboembolism in spinal cord injury: Role of low molecular weight heparin

Cited by 80 publications

References 8 publications

Prophylaxis of thromboembolism in spinal injuries–results of enoxaparin used in 276 patients

Prophylaxis of thromboembolism in spinal injuries–results of enoxaparin used in 276 patients

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury

Deep Vein Thrombosis and Its Prevention in Critically Ill Adults

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