Optimal timing of starting thromboprophylaxis for patients with acute spinal cord injury: A survey of Canadian spine surgeons

Abstract

Patients with acute spinal cord injury (SCI) have a high risk of venous thromboembolism (VTE) especially during the first two weeks after injury [ [1] Merli G.J. Crabbe S. Paluzzi R.G. Fritz D. Etiology, incidence, and prevention of deep vein thrombosis in acute spinal cord injury. Arch. Phys. Med. Rehabil. 1993; 74: 1199-1205 PubMed Google Scholar ]. VTE is common within 90 days after acute injury despite thromboprophylaxis [ [2] Giorgi Pierfranceschi M. Donadini M.P. Dentali F. Ageno W. Marazzi M. Bocchi R. Imberti D. The short- and long-term risk of venous thromboembolism in patients with acute spinal cord injury: a prospective cohort study. Thromb. Haemost. 2013; 109: 34-38 Crossref PubMed Scopus (41) Google Scholar ] with an incidence of 10 to 30% [ 3 Piran S. Schulman S. Incidence and risk factors for venous thromboembolism in patients with acute spinal cord injury: a retrospective study. Thromb. Res. 2016; 147: 97-101 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 4 Clements R. Churilov L. Wahab A.L. Ng L.C. Exploratory analysis of factors associated with venous thromboembolism in Victorian acute traumatic spinal cord-injured patients 2010–2013. Spinal Cord. 2017; 55: 74-78 Crossref PubMed Scopus (14) Google Scholar ]. The incidence of deep vein thrombosis (DVT) in untreated SCI patients ranges from 50 to 100% [ [5] Chen H.L. Wang X.D. Heparin for venous thromboembolism prophylaxis in patients with acute spinal cord injury: a systematic review and meta-analysis. Spinal Cord. 2013; 51: 596-602 Crossref PubMed Scopus (17) Google Scholar ] and pulmonary embolism is the third most common cause of mortality with an incidence of about 5% [ [6] Teasell R.W. Hsieh J.T. Aubut J.A. Eng J.J. Krassioukov A. Tu L. Spinal cord injury rehabilitation evidence review research team. Venous thromboembolism after spinal cord injury. Arch. Phys. Med. Rehabil. 2009; 90: 232-245 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar ]. Therefore, it is vital that this high-risk group receives thromboprophylaxis.