Venous Thromboembolism Chemoprophylaxis Within 24 Hours of Surgery for Spinal Cord Injury: Is It Safe and Effective?

Overview

Journal Neurospine

Date 2020 Jul 4

PMID 32615699

Citations 6

Authors

Seth Ahlquist

Howard Y Park

Benjamin Kelley

Langston Holly

Ayra N Shamie

Don Y Park

Affiliations

Soon will be listed here.

Abstract

Objective: Current guidelines recommend initiation of venous thromboembolism (VTE) chemoprophylaxis within 72 hours of spinal cord injury (SCI). This study investigated the safety and efficacy of chemoprophylaxis within 24 hours of surgery for SCI.

Methods: A retrospective review of 97 consecutive patients who underwent surgery for acute traumatic SCI at a single level 1 trauma center from 2013-2018 was performed. VTE/postoperative bleeding rates during hospitalization, demographics, medical/surgical complications, drain output, length of stay, and disposition were obtained. Chi-square with odds ratios (ORs), 1-way analysis of variance, and logistic regression were performed to establish significant differences between groups.

Results: Seventy-nine patients were included, 49 received chemoprophylaxis within 24 hours and 20 within 24-72 hours. Cohort characteristics included an average age of 51.8 years, 77.2% male, 62.0% cervical, and 35.4% thoracic SCIs. Using the American Spinal Injury Association Impairment Scale (AIS), 39.2% were AIS-A injuries, 19.0% AIS-B, 25.3% AIS-C, and 16.5% AIS-D. Unfractionated heparin was administered in 88.6% of patients and 11.4% received low molecular weight heparin. Chemoprophylaxis within 24 hours of surgery was associated with a lower rate of VTE (6.1% vs. 35.0%; OR, 0.121; 95% confidence interval [CI], 0.027-0.535) and deep vein thrombosis (4.1% vs. 30.0%; OR, 0.099; 95% CI, 0.018-0.548) versus 24-72 hours. Pulmonary embolism rates were not significantly different (6.1% vs. 5.0%, p = 1.0). There were no postoperative bleeding complications and no significant difference in drain output between cohorts.

Conclusion: Early VTE chemoprophylaxis is effective with lower VTE rates when initiated within 24 hours of surgery for SCI and is safe with no observed postoperative bleeding complications.

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References

Gorman P, Qadri S, Rao-Patel A . Prophylactic inferior vena cava (IVC) filter placement may increase the relative risk of deep venous thrombosis after acute spinal cord injury. J Trauma. 2009; 66(3):707-12. DOI: 10.1097/TA.0b013e318188beba. View

Merli G, Herbison G, Ditunno J, Weitz H, Henzes J, Park C . Deep vein thrombosis: prophylaxis in acute spinal cord injured patients. Arch Phys Med Rehabil. 1988; 69(9):661-4. View

Lamb G, Tomski M, Kaufman J, Maiman D . Is chronic spinal cord injury associated with increased risk of venous thromboembolism?. J Am Paraplegia Soc. 1993; 16(3):153-6. DOI: 10.1080/01952307.1993.11735893. View

Chang R, Scerbo M, Schmitt K, Adams S, Choi T, Wade C . Early chemoprophylaxis is associated with decreased venous thromboembolism risk without concomitant increase in intraspinal hematoma expansion after traumatic spinal cord injury. J Trauma Acute Care Surg. 2017; 83(6):1088-1094. PMC: 5709167. DOI: 10.1097/TA.0000000000001675. View

Green D, Lee M, Lim A, Chmiel J, Vetter M, Pang T . Prevention of thromboembolism after spinal cord injury using low-molecular-weight heparin. Ann Intern Med. 1990; 113(8):571-4. DOI: 10.7326/0003-4819-113-8-571. View

Chen H, Wang X . Heparin for venous thromboembolism prophylaxis in patients with acute spinal cord injury: a systematic review and meta-analysis. Spinal Cord. 2013; 51(8):596-602. DOI: 10.1038/sc.2013.48. View

Green D, Lee M, Ito V, COHN T, Press J, Filbrandt P . Fixed- vs adjusted-dose heparin in the prophylaxis of thromboembolism in spinal cord injury. JAMA. 1988; 260(9):1255-8. View

DiGiorgio A, Tsolinas R, Alazzeh M, Haefeli J, Talbott J, Ferguson A . Safety and effectiveness of early chemical deep venous thrombosis prophylaxis after spinal cord injury: pilot prospective data. Neurosurg Focus. 2017; 43(5):E21. DOI: 10.3171/2017.8.FOCUS17437. View

Dhall S, Hadley M, Aarabi B, Gelb D, Hurlbert R, Rozzelle C . Deep venous thrombosis and thromboembolism in patients with cervical spinal cord injuries. Neurosurgery. 2013; 72 Suppl 2:244-54. DOI: 10.1227/NEU.0b013e31827728c0. View

10.

Shavelle R, DeVivo M, Brooks J, Strauss D, Paculdo D . Improvements in long-term survival after spinal cord injury?. Arch Phys Med Rehabil. 2015; 96(4):645-51. DOI: 10.1016/j.apmr.2014.11.003. View

11.

Powell M, Kirshblum S, OConnor K . Duplex ultrasound screening for deep vein thrombosis in spinal cord injured patients at rehabilitation admission. Arch Phys Med Rehabil. 1999; 80(9):1044-6. DOI: 10.1016/s0003-9993(99)90058-8. View

12.

Alabed S, Belci M, van Middendorp J, Al Halabi A, Meagher T . Thromboembolism in the Sub-Acute Phase of Spinal Cord Injury: A Systematic Review of the Literature. Asian Spine J. 2016; 10(5):972-981. PMC: 5081337. DOI: 10.4184/asj.2016.10.5.972. View

13.

. Prevention of venous thromboembolism in the rehabilitation phase after spinal cord injury: prophylaxis with low-dose heparin or enoxaparin. J Trauma. 2003; 54(6):1111-5. DOI: 10.1097/01.TA.0000042159.90102.C2. View

14.

Merli G, Crabbe S, Doyle L, Ditunno J, Herbision G . Mechanical plus pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury. Paraplegia. 1992; 30(8):558-62. DOI: 10.1038/sc.1992.115. View

15.

Lohmann U, Glaser E, Braun B, Botel U . [Prevention of thromboembolism in spinal fractures with spinal cord injuries. Standard heparin versus low-molecular-weight heparin in acute paraplegia]. Zentralbl Chir. 2001; 126(5):385-90. DOI: 10.1055/s-2001-14757. View

16.

Zeeshan M, Khan M, OKeeffe T, Pollack N, Hamidi M, Kulvatunyou N . Optimal timing of initiation of thromboprophylaxis in spine trauma managed operatively: A nationwide propensity-matched analysis of trauma quality improvement program. J Trauma Acute Care Surg. 2018; 85(2):387-392. DOI: 10.1097/TA.0000000000001916. View

17.

Casas E, Sanchez M, Arias C, Masip J . Prophylaxis of venous thrombosis and pulmonary embolism in patients with acute traumatic spinal cord lesions. Paraplegia. 1977; 15(3):209-14. DOI: 10.1038/sc.1977.31. View

18.

Tracy B, Dunne J, ONeal C, Clayton E . Venous thromboembolism prophylaxis in neurosurgical trauma patients. J Surg Res. 2016; 205(1):221-7. DOI: 10.1016/j.jss.2016.06.049. View

19.

Harris S, Chen D, Green D . Enoxaparin for thromboembolism prophylaxis in spinal injury: preliminary report on experience with 105 patients. Am J Phys Med Rehabil. 1996; 75(5):326-7. DOI: 10.1097/00002060-199609000-00002. View

20.

Arnold J, Dart B, Barker D, Maxwell R, Burkholder H, Mejia V . Gold Medal Forum Winner. Unfractionated heparin three times a day versus enoxaparin in the prevention of deep vein thrombosis in trauma patients. Am Surg. 2010; 76(6):563-70. View