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Venous Thromboembolism

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Mirkowski M, Harnett A, McIntyre A, Hsieh JTC, Loh E, Teasell RW, Eng JJ (2020). Venous Thromboembolism Following Spinal Cord Injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Loh E, Sproule S, McIntyre A, Querée M, editors. Spinal Cord Injury Rehabilitation Evidence. Version 7.0: p 1-57.



Key Points

  • Deep venous thrombosis is common among individuals with SCI who are receiving or not receiving prophylaxis.

    Low-dose unfractionated heparin may effectively prevent the risk of developing venous thromboembolic events during the acute phase post SCI if provided early after injury.

    The use of Enoxaparin and Dalteparin (low molecular weight heparin), alone, are effective in reducing the risk of venous thromboembolism during the acute SCI and their effects are comparable.

    Logiparin may be more effective than low-dose unfractionated heparin as venous thromboembolism prophylaxis during the acute phase post SCI.

    Enoxaparin may be more effective than low dose unfractionated heparin in reducing pulmonary embolism and equally effective in reducing deep vein thrombosis in acute SCI.

    Dalteparin appears to be as effective as low-dose unfractionated heparin in reducing risk of venous thromboembolism during acute SCI.

    Sequential compression and gradient elastic stockings may reduce the incidence of venous thromboembolism during the acute phase post SCI.

    Rotating treatment tables may reduce the incidence of venous thromboembolism during the acute phase post SCI.

    Rapid intermittent pulsatile compression devices may stimulate venous blood flow more effectively than sequential compression devices during the chronic phase post SCI.

    Inferior vena cava filters reduce the risk of pulmonary embolism in acute SCI.

    A combination of low-dose unfractionated heparin with intermittent pneumatic compression seems equally as effective as low-molecular-weight heparin alone at reducing this risk.

    There is conflicting evidence regarding the effectiveness of the combination of low- molecular-weight heparin with physical measures at reducing the risk of venous thromboembolism compared to physical measures alone during the acute phase post SCI.