Early thromboprophylaxis should be used to prevent deep-vein thrombosis in patients who have suffered an acute spinal cord injury, according to a meta-analysis in the November issue of the Journal of Bone & Joint Surgery.
Avraam Ploumis, M.D., of Thomas Jefferson University in Philadelphia, and colleagues reviewed the medical literature for clinical trials on thromboprophylaxis following acute spinal injuries, with and without spinal cord injury. The reviewers screened 489 studies, of which 21 met the criteria for their meta-analysis. Outcomes assessed included deep-vein thrombosis, pulmonary embolism, and adverse events.
The researchers found that the cases of deep-vein thrombosis were significantly lower among patients who did not have spinal cord injury than among patients who did (odds ratio, 6.0). Among the patients who had spinal cord injury, those taking oral anticoagulants had significantly fewer pulmonary embolisms than those not taking anticoagulants. Also, there were significantly fewer deep-vein-thrombosis incidents among patients beginning thromboprophylaxis within two weeks of the injury compared to those in whom it was delayed. In addition, heparin-based pharmacoprophylaxis using low-molecular-weight heparin was found superior to unfractionated heparin.
"The prevalence of deep-vein thrombosis following a spine injury is higher among patients who have a spinal cord injury than among those who do not have a spinal cord injury. Therefore, thromboprophylaxis in these patients should start as early as possible once it is deemed safe in terms of potential bleeding complications," the authors write.
Authors of the study reported financial relationships with Medtronic and DePuy Spine