AA

Treatment

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Virtually all research to date on thromboembolism in SCI has focused on prevention rather than treatment. The standard treatment is anticoagulation, generally with intravenous unfractionated heparin immediately followed by a gradual transition to Coumadin which is generally maintained for 3-6 months. A single study compares the cost effectiveness of unfractionated heparin to enoxaparin in the treatment of DVT post SCI.

Table 14: Unfractionated Heparin vs. LMW Heparin

Discussion

Again, there are remarkably few studies examining treatment of venous thromboembolism post SCI with most of the research focus to date on prophylaxis. Tomaio et al. (1988) studied six SCI patients with acute DVT, half of whom were treated with IV heparin followed by warfarin and half who were treated with subcutaneous enoxaparin followed by warfarin. Though the study was extremely small, the author did a careful cost analysis. Subcutaneous enoxaparin was regarded as a safe, cost-effective and simple treatment that could be of substantial benefit in the treatment of DVT in SCI patients.

Conclusions

There is level 4 evidence (from 1 case series study; Tomaio et al. 1998) that subcutaneous enoxaparin is a safe, cost-effective and less labour-intensive compared to intravenous heparin for acute DVTs post SCI.

  • Enoxaparin subcutaneously may be considered as an alternative to intravenous heparin for acute DVTs post SCI.