Efficacy, Safety, and Timing of Anticoagulant Thromboprophylaxis for the Prevention of Venous Thromboembolism in Patients With Acute Spinal Cord Injury: A Systematic Review.

In the Spinal Cord Injury Thromboprophylaxis Investigators (SCITI) trial, 20 patients in the LMWH-only group experienced fewer PE events compared to patients in the UFH plus IPC group (5.2% and 18.4%, respectively); this difference was nearly statistically significant (RD = 13.2, 95% CI = 0.9 to 25.4; RR = 0.28, 95% CI = 0.08 to 0.98; P = .06).

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Three patients (10.3%) in the fixed, low-dose group experienced a PE, whereas no patients in the adjusted group suffered this complication; this difference did not reach statistical significance (RD = 10.3, 95% CI = −0.7 to 21.4; P = .24).

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There may be significant risks to anticoagulant thromboprophylaxis in trauma patients, including symptomatic hematoma formation, enlargement of a spinal cord contusion, worsening of neurologic deficits, bleeding, and mortality. 3 , 4 The objective of this study was to conduct a systematic review to address the following key questions: In adult patients with acute complete or incomplete traumatic SCI, Key Question 1: What is the effectiveness and safety of anticoagulant thromboprophylaxis compared to no prophylaxis, placebo, or another anticoagulant strategy for preventing DVT and PE after acute SCI?

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The risk of DVT was 4 times greater in patients treated without prophylaxis; however, this did not quite reach statistical significance in our conservative analysis ( Table 10 ).

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