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Venous Thromboembolism (Rehab Phase)


VTE following SCI is a source of significant morbidity and mortality. Most research is focused on prophylaxis of VTE in this very high-risk population. Guidelines, based on best available evidence for DVT prophylaxis in SCI, include use of sequential compression devices for two weeks and anticoagulant for eight to 12 weeks after injury (Maxwell et al. 2002). There is evidence that 5000 IU subcutaneously of unfractionated heparin delivered every 12 hours in this population may not be sufficient to provide adequate protection. LMWH with enoxaparin (primary drug studied), appears to be more effective and should be considered the new standard of care, given the added benefit of lower risk of bleeding complications. Physical or mechanical prevention methods, in particular, gradient pressure stockings and intermittent pneumatic compression, are designed to reduce the impact of stasis due to prolonged immobilization of the lower extremities and have been shown to have a limited impact. There is an intuitive benefit to combining treatment (i.e., pharmacological with mechanical treatment) although the evidence suggests pharmacological measures are the more important of the two for the purpose of prophylaxis.

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