The journal of spinal cord medicine · 2025
Venous thromboembolism management in acute traumatic spinal cord injury: Understanding practice patterns within SCI Model Systems.
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Cook Alyssa, Snider Brittany, Draganich Christina, Berliner Jeffrey, Kirshblum Steven
Аннотация
CONTEXT/OBJECTIVE: Venous thromboembolism (VTE) poses significant risks in persons with traumatic spinal cord injury (tSCI) during the acute and sub-acute post-injury phases. This study examines VTE prophylaxis, surveillance, and treatment practices in the inpatient rehabilitation setting.
DESIGN: Cross-sectional.
SETTING: Online.
PARTICIPANTS: SCI providers at Spinal Cord Injury Model Systems (SCIMS).
INTERVENTIONS: Survey via REDCap based upon a case scenario.
OUTCOME MEASURES: The primary aim of the study was to examine current practices related to the screening and prevention of deep vein thrombosis (DVT), as well as the monitoring and treatment of both DVT and pulmonary embolism (PE).
RESULTS: Among 47 providers surveyed about management of a patient with C6 ASIA Impairment Scale (AIS) A tetraplegia 10 days post-injury, 53.2% order routine admission duplex scans (40.0% of those providers obtain scans of both upper and lower limbs). Low molecular weight heparin (LMWH) is the preferred agent for VTE prophylaxis (91%), most commonly enoxaparin 40 mg daily, followed by 30 mg twice daily. Approximately one-third of respondents continue prophylaxis for 8 weeks, another third for 12 weeks, and the remainder varied based on individual circumstances. For proximal DVT treatment, 61.1% prescribe a LMWH followed by a direct oral anticoagulant (DOAC), and 30.6% use a DOAC alone, with the majority of providers treating for 3 months.
CONCLUSION: This survey highlights diverse practices amongst tSCI providers regarding diagnostic testing, VTE prophylaxis, and treatment approaches for persons with tSCI in SCIMS centers. The variability underscores the need for high-quality research and updated, SCI-specific clinical guidelines.
DESIGN: Cross-sectional.
SETTING: Online.
PARTICIPANTS: SCI providers at Spinal Cord Injury Model Systems (SCIMS).
INTERVENTIONS: Survey via REDCap based upon a case scenario.
OUTCOME MEASURES: The primary aim of the study was to examine current practices related to the screening and prevention of deep vein thrombosis (DVT), as well as the monitoring and treatment of both DVT and pulmonary embolism (PE).
RESULTS: Among 47 providers surveyed about management of a patient with C6 ASIA Impairment Scale (AIS) A tetraplegia 10 days post-injury, 53.2% order routine admission duplex scans (40.0% of those providers obtain scans of both upper and lower limbs). Low molecular weight heparin (LMWH) is the preferred agent for VTE prophylaxis (91%), most commonly enoxaparin 40 mg daily, followed by 30 mg twice daily. Approximately one-third of respondents continue prophylaxis for 8 weeks, another third for 12 weeks, and the remainder varied based on individual circumstances. For proximal DVT treatment, 61.1% prescribe a LMWH followed by a direct oral anticoagulant (DOAC), and 30.6% use a DOAC alone, with the majority of providers treating for 3 months.
CONCLUSION: This survey highlights diverse practices amongst tSCI providers regarding diagnostic testing, VTE prophylaxis, and treatment approaches for persons with tSCI in SCIMS centers. The variability underscores the need for high-quality research and updated, SCI-specific clinical guidelines.