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Heterotopic Ossification

Warfarin as Prophylaxis

Warfarin is a well-known anticoagulant which may also be useful in the prevention of HO post SCI.

Author Year; Country
Research Design
Total Sample Size
Methods Outcome
Buschbacher et al. 1992; USA

Population: Age range: 17-75 yr; Gender: males=213, females=14; Severity of injury: complete, incomplete.
Treatment: Patients treated with warfarin for a mean of 5.4 wk post SCI for deep vein thrombosis; no X-rays taken to rule out HO. HO, diagnostic tests done only if clinical signs were suggestive.
Outcome Measures: Prevalence of HO.

  1. Warfarin administration and development of HO were found to be significantly related (p<0.01).
  2. None of the patients treated with Warfarin (n=33) developed HO and none of the patients with HO (n=34) had been treated with Warfarin.


There is only one observational retrospective study which noted an association between Warfarin use and HO post SCI. Buschbacher et al. (1992) studied 227 patients with SCI. None of the 33 patients treated with Warfarin post SCI were diagnosed with HO; among the remaining 193 patients, 34 were diagnosed with HO but not one of these individuals had been treated with Warfarin. The authors speculated that Warfarin provided a protective or inhibitory effect against HO.


There is Level 5 evidence (from one observational study: Buschbacher et al. 1992) that Warfarin inhibits the development of heterotopic ossification post spinal cord injury.

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