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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Spinal 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Forty-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.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>A 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.</jats:p></jats:sec>

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

“…Duplex ultrasound was performed if there was clinical suspicion for DVT/PE. 11,17,26,28,31,38 Routine duplex ultrasounds were not obtained due to the increased cost and resource utilization required for obtaining the study in all SCI patients. PE was confirmed with computed tomography angiography.…”

“…17,24,29,33 The higher rates of VTE reported by the SCI thromboprophylaxis investigators study may be due to their protocol incorporating routine surveillance with ultrasonography as opposed to our study which did so only when there was clinical suspicion. 36 Multiple studies in the literature have previously utilized clinical suspicion as the trigger to obtain the duplex ultrasound 11,17,26,28,31,38 and a recent systematic review found insufficient evidence to support the hypothesis that routine surveillance decreases VTE-associated morbidity/mortality. 34 Aito et al 36 performed a direct comparison of 275 consecutive acute SCI patients and found a low rate of DVT in those who received LMWH within 72 hours of injury (2%), which was a significantly lower DVT rate than in those with delayed LMWH administration 8-28 days after injury (26%).…”

“…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.…”

Thromboprophylaxis in Patients with Acute Spinal Cord Injury: A Narrative Review

“…The timing of starting thromboprophylaxis has been examined in observational studies. [39][40][41][42] A prospective study evaluated the efficacy of using a protocol for prevention of VTE in 275 patients with acute SCI based on concomitant use of nadroparin 0.4 mL once daily and combination of external sequential pneumatic compression (ESPC), permanently dressed gradient elastic stockings, and early mobilization of the lower limbs. 39 Prophylaxis was administered to 99 patients within 72 hours (early-admitted patients), while the other group of 176 patients (late-admitted patients) received prophylaxis from 7 to 28 days postinjury (mean 12 days).…”

“…The TRACK-SCI evaluated the safety and effectiveness of early start of enoxaparin 40 mg once daily within 24 hours of injury in a pilot prospective study. 41 Forty-nine patients were enrolled from May 2015 to March 2017. There were three symptomatic DVTs (6.1%) and two PEs (4.1%) despite thromboprophylaxis.…”