Abstract
Patients with acute spinal cord injury (SCI) have the highest risk of venous thromboembolism
(VTE) among hospitalized patients. The incidence of total deep vein thrombosis ranges
from 50 to 100% in untreated patients and pulmonary embolism is the third most common
cause of mortality in these patients. The pathophysiology of the increased risk of
VTE is explained by venous stasis after injury, endothelial vessel wall injury from
surgery, and a hypercoagulable state associated with trauma. The current thromboprophylaxis
options are limited, with low-molecular-weight heparin (LMWH) being the current standard
of care. LMWH is commonly administered for 3 months, during which period the risk
of VTE is especially high. Some uncertainty exists regarding the optimal timing to
initiate pharmacological thromboprophylaxis and the best regimen of LMWH prophylaxis.
High-quality data are currently lacking in thromboprophylaxis in patients with SCI.
Many questions in this area remain to be answered, which are described in this narrative
review.
Keywords
direct oral anticoagulants - low-molecular-weight heparin - thromboprophylaxis - spinal
cord injury - venous thromboembolism
