Venous thromboembolism and anticoagulation in spinal cord lesion rehabilitation inpatients: A 10-year retrospective study.
Vadim Bluvshtein, Amiram Catz, Ala Mahamid and 6 others
PMID 37424485WHAT IT FOUND
Standard low-dose enoxaparin prophylaxis reduced VTE rates compared to historical data but failed to prevent them in 3% of patients during rehabilitation.
Late VTEs occurred after discontinuation, and side effects were rare, suggesting the current regimen is insufficient and requires risk-adapted dosing and duration.
Key findings
01VTE occurred in 3% of patients who received preventive anticoagulation during rehabilitation, with many events happening after prophylaxis was stopped.
02Patients with higher AIS grades (A-C) and a history of VTE had significantly higher risk of developing thromboembolism compared to those with grade D or no history.
03Side effects from prophylaxis were rare, occurring in 1.5% of treated patients, with bleeding events not resulting in death.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study is retrospective, so data on VTE incidence and prophylaxis before admission to the rehabilitation center is missing. Objective imaging (ultrasound or CT) was not documented for all VTE cases, though the authors argue clinical diagnosis was robust. The study did not test the proposed risk-adapted dosing regimen; these are recommendations for future prospective trials. VTE rates may be underestimated if patients developed clots after discharge but before the one-year follow-up window closed, or if they were treated in other facilities.
Declared interests
The authors declare no commercial or financial conflicts of interest. The work was supported by a grant from the Loewenberg Hospital.
The easy way to misread this
Do not assume that standard low-dose enoxaparin prophylaxis provides complete protection against VTE in all spinal cord injury patients, especially those with AIS grades A-C or a history of VTE, as 3% of treated patients still developed clots, mostly after stopping the medication.