Venous thromboembolism after spinal cord injury

Arch Phys Med Rehabil. 2009 Feb;90(2):232-45. doi: 10.1016/j.apmr.2008.09.557.

Abstract

Objective: To review systematically the published literature on the treatment of deep venous thromboembolism after spinal cord injury (SCI).

Data sources: MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing the treatment of deep venous thromboembolism post-SCI. Randomized controlled trials (RCTs) were assessed for methodologic quality using the Physiotherapy Evidence Database Scale, while non-RCTs were assessed using the Downs and Black evaluation tool.

Study selection: Studies included RCTs, non-RCTS, cohort, case-control, case series, pre-post, and postinterventional studies. Case studies were included only when no other studies were available.

Data extraction: Data extracted included demographics, the nature of the study intervention, and study results.

Data synthesis: Levels of evidence were assigned to the interventions using a modified Sackett scale.

Conclusions: Twenty-three studies met inclusion criteria. Thirteen studies examined various pharmacologic interventions for the treatment or prevention of deep venous thrombosis in patients with SCI. There was strong evidence to support the use of low-molecular-weight heparin in reducing venous thrombosis events, and a higher adjusted dose of unfractionated heparin was found to be more effective than 5000 units administered every 12 hours, although bleeding complications were more common. Nonpharmacologic treatments were also reviewed, but again limited evidence was found to support these treatments.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anticoagulants / therapeutic use*
  • Clinical Trials as Topic
  • Demography
  • Hemofiltration
  • Heparin / therapeutic use*
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Intermittent Pneumatic Compression Devices
  • Spinal Cord Injuries / complications*
  • Venous Thromboembolism / etiology*
  • Venous Thromboembolism / prevention & control*
  • Venous Thromboembolism / therapy

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • Heparin