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

Ahlquist, Seth; Park, Howard Y.; Kelley, Benjamin; Holly, Langston T.; Shamie, Ayra N.; Park, Don Y.

doi:10.14245/ns.1938420.210

Cited by 13 publications

(15 citation statements)

References 41 publications

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“…Comprehensive evaluation of the 17 selected manuscripts was conducted. Finally, five articles were found to meet the inclusion criteria of this meta-analysis [ 16 – 20 ]. The details of the included cohort studies are shown in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Four studies compared the effects of LMWH and UFH in preventing VTE in patients with SCI [ 16 , 18 – 20 ]. The incidence of VTE in the LMWH treatment group was 10.3–53.4%, and the incidence of VTE in the UFH treatment group was 4.0–77.6%.…”

Section: Resultsmentioning

confidence: 99%

“…The American Spinal Injury Association Impairment Scale (AIS) is used to assess spinal cord injury [ 22 ]. Two of the five studies used AIS scores to assess patients’ spinal cord injury [ 16 , 18 ]. The A/B level indicates that the spinal cord injury is more serious, and the C/D/E level indicates that the spinal cord injury is relatively mild.…”

Section: Resultsmentioning

confidence: 99%

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The effectiveness and safety of LMWH for preventing thrombosis in patients with spinal cord injury: a meta-analysis

Lin¹,

Sun²,

Xue³

et al. 2021

J Orthop Surg Res

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Background Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used for preventing venous thrombosis of the lower extremity in patients with traumatic spinal cord injury. Although, LMWH is the most commonly used drug, it has yet to be established whether it is more effective and safer than UFH. Further, a comparison of the effectiveness of LMWH in preventing thrombosis at different locations and different degrees of spinal cord injury has also not been clearly defined. Materials and methods Cohort studies comparing the use of LMWH and UFH in the prevention of lower limb venous thrombosis in patients with spinal cord injury were identified using PubMed. The risk of bias and clinical relevance of the included studies were assessed using forest plots. The Newcastle-Ottawa quality assessment scale was used to evaluate the quality of the included studies. The main results of the study were analyzed using Review Manager 5.3. Results A total of five studies were included in this meta-analysis. Four studies compared the effectiveness and safety of LMWH and UFH in preventing thrombosis in patients with spinal cord injury. No significant differences were found between the therapeutic effects of the two drugs, and the summary RR was 1.33 (95% CI 0.42–4.16; P = 0.63). There was also no significant difference in the risk of bleeding between the two medications, and the aggregate RR was 0.78 (95% CI 0.55–1.12; P = 0.18). When comparing the efficacy of LMWH in preventing thrombosis in different segments and different degrees of spinal cord injury, no significant differences were found. Conclusions The results of this analysis show that compared with UFH, LMWH has no obvious advantages in efficacy nor risk prevention, and there is no evident difference in the prevention of thrombosis for patients with injuries at different spinal cord segments.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The effectiveness and safety of LMWH for preventing thrombosis in patients with spinal cord injury: a meta-analysis

Lin¹,

Sun²,

Xue³

et al. 2021

J Orthop Surg Res

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“…For these reasons, determining the optimal timing of initiation of chemoprophylaxis following SCI or spinal fracture is of paramount importance, but is also somewhat controversial. While the overall strength of scientific evidence is low, it appears that initiation of pharmacologic VTE prophylaxis within 48 hours of injury or spine surgery is associated with a reduced incidence of DVT and PE, with no associated increase in hemorrhagic complications 55–57 …”

Section: Protocol Rationale and Goalsmentioning

confidence: 99%

American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Protocol for inpatient venous thromboembolism prophylaxis after trauma

Yorkgitis

Berndtson

Cross

et al. 2021

J Trauma Acute Care Surg

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Trauma patients are at increased risk of venous thromboembolism (VTE), which includes both deep vein thrombosis and pulmonary embolism. Pharmacologic VTE prophylaxis is a critical component of optimal trauma care that significantly decreases VTE risk. Optimal VTE prophylaxis protocols must manage the risk of VTE with the competing risk of hemorrhage in patients following significant trauma. Currently, there is variability in VTE prophylaxis protocols across trauma centers. In an attempt to optimize VTE prophylaxis for the injured patient, stakeholders from the American Association for the Surgery of Trauma and the American College of Surgeons-Committee on Trauma collaborated to develop a group of consensus recommendations as a resource for trauma centers. The primary goal of these recommendations is to help standardize VTE prophylaxis strategies for adult trauma patients (age ≥15 years) across all trauma centers. This clinical protocol has been developed to (1) provide standardized medication dosing for VTE prophylaxis in the injured patient; and (2) promote evidence-based, prompt VTE prophylaxis in common, high-risk traumatic injuries.

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“…Studies have reported that if DVT is not treated in time, it can lead to patients with large-scale pulmonary embolism and the incidence rate is 20 %-30 % [7] . DVT treatment includes a lot of joint contents such as thrombolytic therapy, anticoagulation, Inferior Vena Cava (IVC) filter indwelling, mechanical thrombectomy, Traditional Chinese Medicine (TCM), acupoint compression and psychological intervention [8,9] .…”

mentioning

confidence: 99%

The Clinical Efficacy of Maizhiling Combined with Low Molecular Weight Heparin in the Treatment of Deep Vein Thrombosis after Spinal Cord Injury

Ma¹,

Liu²,

Wang³

et al. 2021

IJPS

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This research aims to discuss the clinical efficacy of Maizhiling combined with low molecular weight heparin calcium in the treatment of deep vein thrombosis after spinal cord injury, in the meantime to discuss the effects of the drug combination on coagulation function, hemodynamics and clinical safety. We chose 40 patients with deep vein thrombosis after spinal cord injury in our hospital as the study cohort divided them into control group (n=20) and observation group (n=20) randomly. The control group received low molecular weight heparin calcium subcutaneous injections while the observation group received low molecular weight heparin calcium intravenous infusion of low molecular weight heparin calcium and oral Maizhiling. Then make a contrast of the affected limbs detumescence time, lower limb circumference, coagulation parameters, overall response rate, incidence of complications and adverse drug reactions after treatment between both groups. After treatment, the observation group's swelling time and the average difference of lower limb circumference were significantly reduced (p<0.01), prothrombin time, activated partial thromboplastin time and D-dimer both were significantly lower (p<0.01) and the clinical effective rate was higher (p<0.05). Both groups incidence of complications and adverse drug reactions have no significant difference (p>0.05). Low molecular weight heparin calcium combined with Maizhiling is effective on spinal cord injury deep vein thrombosis patients. The lower extremity swelling time is significantly shortened, the blood coagulation function and blood viscosity are improved, and the adverse drug incidence and complications are not increased. The combined use is used to treat patients with deep vein thrombosis. It is worth widely using in clinical practice.

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

Cited by 13 publications

References 41 publications

The effectiveness and safety of LMWH for preventing thrombosis in patients with spinal cord injury: a meta-analysis

The effectiveness and safety of LMWH for preventing thrombosis in patients with spinal cord injury: a meta-analysis

American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Protocol for inpatient venous thromboembolism prophylaxis after trauma

The Clinical Efficacy of Maizhiling Combined with Low Molecular Weight Heparin in the Treatment of Deep Vein Thrombosis after Spinal Cord Injury

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