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BMC Musculoskelet Disord 2021 Apr 22;22(1):377. Epub 2021 Apr 22.

Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Higashi-4, Minami-1, 3-1, Bibai, Hokkaido, 072-0015, Japan.

Background: Osteoporotic vertebral compression fractures (VCFs) are commonly observed in elderly people and can be treated by conservatively with minimal risk of complications in most cases. However, utilization of direct oral anticoagulants (DOACs) increases the risks of secondary hematoma even after insignificant trauma. The use of DOACs increased over the past decade because of their approval and recommendation for both stroke prevention in non-valvular atrial fibrillation and treatment of venous thromboembolism. Read More

J Orthop Surg Res 2021 Apr 14;16(1):262. Epub 2021 Apr 14.

Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road. 1277#, Wuhan, 430022, Hubei, P. R. China.

Background: Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used for preventing venous thrombosis of the lower extremity in patients with traumatic spinal cord injury. Although, LMWH is the most commonly used drug, it has yet to be established whether it is more effective and safer than UFH. Further, a comparison of the effectiveness of LMWH in preventing thrombosis at different locations and different degrees of spinal cord injury has also not been clearly defined. Read More

Neurol Res Pract 2020 10;2:43. Epub 2020 Dec 10.

BG Unfallklinik Frankfurt/M., Frankfurt/M., Germany.

Introduction: Traumatic and non-traumatic spinal cord injury bears a high risk for thromboembolism in the first few months after injury. So far, there is no consented guideline regarding diagnostic and prophylactic measures to prevent thromboembolic events in spinal cord injury. Based on a Pubmed research of related original papers and review articles, international guidelines and a survey conducted in German-speaking spinal cord injury centers about best practice prophylactic procedures at each site, a consensus process was initiated, which included spinal cord medicine experts and representatives from medical societies involved in the comprehensive care of spinal cord injury patients. Read More

Spine (Phila Pa 1976) 2020 Dec;45(23):1613-1618

Department of Neurosurgery, Mount Sinai Hospital, New York, NY.

Study Design: Retrospective review of prospectively collected data.

Objective: The objective of this study was to evaluate outcomes between patients receiving LMWH versus UH in a retrospective cohort of patients with spine trauma.

Summary Of Background Data: Although multiple clinical trials have been conducted, current guidelines do not have enough evidence to suggest low-molecular-weight heparin (LMWH) or unfractionated heparin (UH) for venous thromboembolism (VTE) prophylaxis in spine trauma. Read More

J Surg Res 2021 02 8;258:289-298. Epub 2020 Oct 8.

Department of Surgery, University of Colorado-Denver, Aurora, Colorado.

Background: Venous thromboembolism chemoprophylaxis (VTE-CHEMO) is often delayed in patients with traumatic brain injury because of the concern for intracranial hemorrhage (ICH) progression. We hypothesize that (1) late time to VTE-CHEMO (≥48 h) is associated with higher incidence of VTE, and (2) VTE-CHEMO use does not correlate with ICH progression.

Materials And Methods: This is a multiinstitutional retrospective study of patients with traumatic brain injury admitted between 2014 and 2016. Read More

Trials 2020 Sep 9;21(1):770. Epub 2020 Sep 9.

Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland.

Objectives: The OVID study will demonstrate whether prophylactic-dose enoxaparin improves survival and reduces hospitalizations in symptomatic ambulatory patients aged 50 or older diagnosed with COVID-19, a novel viral disease characterized by severe systemic, pulmonary, and vessel inflammation and coagulation activation.

Trial Design: The OVID study is conducted as a multicentre open-label superiority randomised controlled trial.

Participants: Inclusion Criteria 1. Read More

Injury 2020 Jan 1;51(1):10-14. Epub 2019 Nov 1.

Department of Hyperbaric and Intensive Care Medicine, Alfred Health, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.

Objective: To quantify the pharmacodynamic (PD) activity of daily subcutaneous (SC) enoxaparin as venous thromboembolism (VTE) prophylaxis in high-risk trauma patients admitted to the intensive care unit (ICU).

Methods: This was a prospective observational PD study conducted in the ICU of a state-wide major trauma referral centre. The study cohort included adult patients admitted to the ICU with a high risk of VTE, as defined by at least one of the following: age > 40 years, prior VTE, spinal cord injury (SCI), traumatic brain injury (TBI), major venous injury, pelvic fractures, spinal fractures requiring treatment, severe lower limb injuries, and major surgery >2 h in duration. Read More

Spinal Cord Ser Cases 2019 16;5:36. Epub 2019 Apr 16.

2Laboratory of Respiratory Physiology, University of Brasília, Brasília, Brazil.

Introduction: Acute spinal cord injury is associated with an increased risk of thromboembolic events. Low-molecular-weight heparins are first-line medications for both the treatment and prevention of venous thromboembolism. Pharmacological prophylaxis may be indicated for high-risk patients and low-risk patients may be managed with non-pharmacological measures. Read More

Spinal Cord 2019 Oct 17;57(10):890-896. Epub 2019 May 17.

Laboratory of Respiratory Physiology, University of Brasília, Brasília, Brazil.

Study Design: Retrospective cohort study.

Objective: To compare the cost and incidence of venous thromboembolism (VTE) and bleeding between two different VTE pharmacological prophylaxis strategies in individuals with spinal cord injury: one based on motor impairment (Protocol 1) and the other based on time from the lesion and presence of associated risk factors for VTE (Protocol 2).

Setting: A tertiary rehabilitation hospital in Brazil. Read More

J Thromb Haemost 2019 06 13;17(6):925-933. Epub 2019 Apr 13.

Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.

Essentials Operative spine trauma patients are at increased risk of venous thromboembolism (VTE). Direct oral anticoagulants (DOACs) may have a favorable efficacy and safety in spine trauma. Patients on DOACs had lower rates of VTE in comparison to low molecular weight heparin. Read More

Semin Thromb Hemost 2019 Mar 11;45(2):150-156. Epub 2019 Feb 11.

Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.

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. Read More

Ann Vasc Surg 2019 Apr 27;56:24-28. Epub 2018 Nov 27.

Jobst Vascular Institute, and Division of Vascular Surgery of the University of Michigan, ProMedica Toledo Hospital, Toledo, OH. Electronic address:

Background: The aim of this study is to describe the timing of venous thromboembolism (VTE) diagnosis in patients with cerebral or spinal trauma and stroke and describe the relationships between VTE prophylaxis and timing of VTE diagnosis at a community hospital.

Methods: Retrospective cohort observational study over a span of 10 years from 2006 to 2016 was conducted.

Results: Lower extremity ultrasound surveillance identified 138 patients who developed VTE during their hospital stay (mean age 62 years, 61. Read More

Neurosurgery 2019 01;84(1):E39-E42

Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois.

Question 1: Does routine screening for deep venous thrombosis prevent pulmonary embolism (or venous thromboembolism (VTE)-associated morbidity and mortality) in patients with thoracic and lumbar fractures?

Recommendation 1: There is insufficient evidence to recommend for or against routine screening for deep venous thrombosis in preventing pulmonary embolism (or VTE-associated morbidity and mortality) in patients with thoracic and lumbar fractures. Strength of Recommendation: Grade Insufficient.

Question 2: For patients with thoracic and lumbar fractures, is one regimen of VTE prophylaxis superior to others with respect to prevention of pulmonary embolism (or VTE-associated morbidity and mortality)?

Recommendation 2: There is insufficient evidence to recommend a specific regimen of VTE prophylaxis to prevent pulmonary embolism (or VTE-associated morbidity and mortality) in patients with thoracic and lumbar fractures. Read More

Pediatr Crit Care Med 2018 09;19(9):e448-e454

Division of Critical Care, Department of Pediatrics, Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI.

Objectives: Frequency of venous thromboembolism in pediatric trauma patients admitted to PICUs is not insignificant, ranging up to 6%. Risk factors have been identified in this population. However, there is little consensus of actual venous thromboembolism prophylaxis practice. Read More

World J Urol 2018 Oct 28;36(10):1529-1536. Epub 2018 May 28.

Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.

Purpose: Considering the major clinical challenges of managing patients with spinal cord injury (SCI), we summarized the relevant aspects of the early (within 1 year after SCI) neurological care emphasizing common standards.

Methods: This review was performed according to the methodology recommended by the Joint SIU-ICUD International Consultation. Embase and Medline databases were used to identify literature relevant to the early neurological care of SCI patients. Read More

J Spinal Cord Med 2019 03 7;42(2):228-235. Epub 2018 May 7.

a Departments of Orthopaedics.

Objective: To determine the prevalence and variation of inferior vena cava filter (IVCF) use in the spine trauma population and evaluate patient and facility level factors associated with their use.

Study Design: Retrospective cohort. Participants/Outcome Measures: Patients with spinal injuries were identified by ICD-9 codes from the National Trauma Data Bank (NTDB), the best validated national trauma database. Read More

Global Spine J 2017 Sep 5;7(3 Suppl):138S-150S. Epub 2017 Sep 5.

Spectrum Research, Inc, Tacoma, WA, USA.

Study Design: Systematic review.

Objectives: The objective of this study was to answer 5 key questions: What is the comparative effectiveness and safety of (1a) anticoagulant thromboprophylaxis compared to no prophylaxis, placebo, or another anticoagulant strategy for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) after acute spinal cord injury (SCI)? (1b) Mechanical prophylaxis strategies alone or in combination with other strategies for preventing DVT and PE after acute SCI? (1c) Prophylactic inferior vena cava filter insertion alone or in combination with other strategies for preventing DVT and PE after acute SCI? (2) What is the optimal timing to initiate and/or discontinue anticoagulant, mechanical, and/or prophylactic inferior vena cava filter following acute SCI? (3) What is the cost-effectiveness of these treatment options?

Methods: A systematic literature search was conducted to identify studies published through February 28, 2015. We sought randomized controlled trials evaluating efficacy and safety of antithrombotic strategies. Read More

Cochrane Database Syst Rev 2017 11 21;11:CD011764. Epub 2017 Nov 21.

Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Prescot Street, Liverpool, UK, L7 8XP.

Background: Venous thromboembolism (VTE) is a serious but preventable cause of morbidity and mortality. Neuromuscular electrical stimulation systems (NMES) for the prevention of VTE may be beneficial for patients in whom pharmacological or standard mechanical prophylaxis methods are contraindicated or are regarded as unsafe or impractical. Although findings of experimental studies suggest that NMES reduce venous stasis, the clinical utility and effectiveness of NMES in VTE prevention remain controversial. Read More

Surg Clin North Am 2017 Oct;97(5):1031-1045

Department of Surgery, General Surgery, Madigan Army Medical Center, 9040-A Jackson Avenue, Tacoma, WA 98431, USA; Trauma and Emergency Surgery Service, Legacy Emanuel Medical Center, 501 N. Graham Street, #580, Portland OR 97227, USA.

Injuries to the spinal column and spinal cord frequently occur after high-energy mechanisms of injury, or with lower-energy mechanisms, in select patient populations like the elderly. A focused yet complete neurologic examination during the initial evaluation will guide subsequent diagnostic procedures and early supportive measures to help prevent further injury. For patients with injury to bone and/or ligaments, the initial focus should be spinal immobilization and prevention of inducing injury to the spinal cord. Read More

Ann Vasc Surg 2018 Jan 7;46:36-42. Epub 2017 Sep 7.

Division of Vascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, AZ. Electronic address:

Background: The lack of evidence-based guidelines on the use of prophylactic inferior vena cava filters (IVCFs) in patients after trauma has led to variation of its application. We seek to understand the national trend of the use of prophylactic IVCF in trauma population.

Methods: A retrospective review of the National Trauma Databank (2002-2014) was performed to identify patients who received an IVCF after trauma. Read More

J Trauma Acute Care Surg 2017 12;83(6):1088-1094

From the Center for Translational Injury Research (R.C., M.H.S, S.D.A., T.J.C., C.E.W., J.B.H.), University of Texas Health Science Center, Houston, Texas; Department of Surgery, McGovern Medical School (R.C., M.H.S., S.D.A., C.E.W., J.B.H.), Houston, Texas; and Department of Neurosurgery (K.M.S.), McGovern Medical School, Houston, Texas.

Background: After traumatic spinal cord injury (SCI), there is increased risk of venous thromboembolism (VTE), but chemoprophylaxis (PPX) may cause expansion of intraspinal hematoma (ISH).

Methods: Single-center retrospective study of adult trauma patients from 2012 to 2015 with SCI.

Exclusion Criteria: VTE diagnosis, death, or discharge within 48 hours. Read More

J Trauma Acute Care Surg 2017 12;83(6):1108-1113

From the University of Tennessee Health Science Center, Memphis, Tennessee (J.P.S., W.C.G., A.M.C, M.K.P., M.S.M., F.X.C., T.C.F., M.A.C., L.J.M.).

Background: Prophylactic anticoagulation may decrease the risk of venous thromboembolism (VTE) in patients with spine fractures following blunt trauma but comes with the threat of postoperative bleeding in patients requiring stabilization of these fractures. The purpose of this study was to evaluate the impact of preoperative anticoagulation on VTE and bleeding complications in patients with blunt spine fractures requiring operative stabilization.

Methods: All patients with blunt spine fractures requiring operative stabilization over a 6-year period were identified. Read More

Int J Surg 2017 Jul 1;43:94-100. Epub 2017 Jun 1.

Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China. Electronic address:

Objective: Venous thromboembolism (VTE) is a frequent complication in patients with acute spinal cord injury (SCI) and may have serious consequences. This study aimed to assess the efficacy and safety of heparin and low-molecular-weight heparin (LMWH) venous thromboprophylaxis in patients with acute SCI.

Methods: PubMed, Web of Science, EMBASE and the Cochrane library were searched from January 1980 to August 2016. Read More

Ann Cardiol Angeiol (Paris) 2017 Apr 19;66(2):92-101. Epub 2017 Jan 19.

Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie.

Venous thromboembolism (VTE) remains a major challenge in critically ill patients. Subjects admitted in intensive care unit (ICU), in particular trauma patients, are at high-risk for both deep vein thrombosis (DVT) and pulmonary embolism (PE). The rate of symptomatic PE in injured patients has been reported previously ranging from 1 to 6%. Read More

Plast Reconstr Surg 2016 Nov;138(5):908e-914e

Orange and Long Beach, Calif.

Background: Venous thromboembolic events result in significant morbidity, mortality, and costly therapeutic interventions. As medical resource allocation strategies are becoming more pervasive, appropriate risk stratification and prophylactic regimens are essential. Previous studies have shown a decreased incidence of perioperative venous thromboembolism in the chronic spinal cord injury population. Read More

J Surg Res 2016 09 24;205(1):221-7. Epub 2016 Jun 24.

Department of Surgery, Memorial University Medical Center, Savannah, Georgia.

Background: Venous thromboembolisms (VTEs) occur more frequently in patients with traumatic brain injuries (TBIs) and spinal cord injuries, yet the use of chemoprophylaxis is controversial. The purpose of this study was to investigate the relationship between the timing of chemical VTE prophylaxis initiation and the development of VTE events in these patients.

Methods: Prospective data were collected and retrospectively reviewed on 1425 patients sustaining TBIs or spinal injuries from 2010 to 2014. Read More

Top Spinal Cord Inj Rehabil 2016 ;22(3):209-240

Am Surg 2015 Jun;81(6):605-9

Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Venous thromboembolism (VTE) is a leading cause of death in multisystem trauma patients; the importance of VTE prevention is well recognized. Presently, standard dose enoxaparin (30 mg BID) is used as chemical prophylaxis, regardless of weight or physiologic status. However, evidence suggests decreased bioavailability of enoxaparin in critically ill patients. Read More

J Trauma Acute Care Surg 2015 Mar;78(3):475-80; discussion 480-1

Background: Trauma patients are known to be at increased risk for venous thromboembolism (VTE); this risk may change over time following injury. Determining the period in which patients are at increased risk of developing VTE may have an impact on prophylaxis, cost, and quality of care.

Methods: The California Office of Statewide Health Planning and Development hospital discharge database was searched between 1995 and 2010 for patients admitted with traumatic pelvic fractures, vertebral fractures, and spinal cord injuries. Read More

Khirurgiia (Mosk) 2014 (3):49-52

It was analyzed the results of diagnosis and prevention of venous thromboembolic complications in 248 patients with intracranial hemorrhages of different etiology (hemorrhagic stroke, subarachnoid hemorrhage, craniocerebral injury, hemorrhages in the tumors of brain and spinal cord). The overall frequency of venous thrombosis in the vessels of the inferior vena cava pool was 24.6% (in 61 patients), the majority of patients had the asymptomatic thrombosis. Read More