Search Our Scientific Publications & Authors

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 Jan;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

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

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. From the Departments of Plastic Surgery and Surgery, University of California Irvine Medical Center; and Veterans Affairs Long Beach Healthcare System.

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

AJNR Am J Neuroradiol 2014 May 27;35(5):856-61. Epub 2014 Mar 27.

Department of Neuroradiology (R.S.), Radiology Associates of North Texas, Fort Worth, Texas.

Background And Purpose: Antecedent balloon test occlusion is often performed prior to vertebral artery sacrifice, but there is limited data to suggest this adds a significant clinical benefit, especially in the setting of trauma. Furthermore, balloon test occlusion can be time-consuming, add to the technical complexity of the procedure, and increase the overall cost of treatment. The purpose of this study was to determine the safety of unilateral vertebral artery occlusion without antecedent balloon test occlusion as part of the treatment regimen in patients with traumatic vertebral artery dissection, cervical tumor, or intracranial aneurysm. Read More

Spine (Phila Pa 1976) 2013 Nov;38(23):E1498-502

From the Department of Neurosurgery, New York University Langone Medical Center, New York.

Study Design: Retrospective review.

Objective: To assess the safety and efficacy of prophylactic low-molecular-weight heparin (LMWH) started 24 to 36 hours after degenerative spine surgery.

Summary Of Background Data: Venous thromboembolism (VTE) is a significant postoperative complication best averted with dual mechanical/pharmacological prophylaxis. Read More

J Pediatr Surg 2013 Jun;48(6):1413-21

Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.

Background/purpose: The aim of this study was to review evidence-based literature addressing pertinent questions about venous thromboembolism (VTE) after traumatic injury in children.

Methods: Data were obtained from English-language articles identified through Pubmed published from 1995 until November 2012, and from bibliographies of relevant articles. Studies were included if they contributed evidence to one of the following questions. Read More

Spinal Cord 2013 Aug 21;51(8):596-602. Epub 2013 May 21.

Nantong University, Nantong city, People's Republic of China.

Objective: The objective of this study is to systematically review and estimate the effect of heparin for thromboprophylaxis in patients with acute spinal cord injury (SCI).

Methods: We searched the PubMed database up to February 2013. Only randomized control trials (RCTs), quasi-RCTs, cohorts, case-control and cross-sectional studies were included. Read More

Acta Orthop Traumatol Turc 2013 ;47(2):111-7

Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.

Objective: Clinical features of respiratory complications in patients with upper cervical spine injuries (CSI) are unique due to the complex regional anatomy in the region. The objective of this study was to identify the risk factors for respiratory complications in the patients with upper CSI and cervical spinal cord injuries (C-SCI).

Methods: Ninety-two patients (out of 1593 spine injured patients) who met the inclusion criteria of upper CSI were admitted to our hospital from 1992 to 2010. Read More

Neurosurgery 2013 Mar;72 Suppl 2:244-54

Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.

Thromb Haemost 2013 Jan 6;109(1):34-8. Epub 2012 Dec 6.

Emergency Department, Hospital of Piacenza, Via Taverna 49, Piacenza 29121, Italy.

Venous thromboembolism (VTE) is a frequent complication in the acute setting after spinal cord injury (SCI). Less is known about the long-term risk of VTE in these patients. It was the aim of this study to prospectively evaluate the short- and long-term risk of VTE in a cohort of patients after acute SCI and during rehabilitation and post-rehabilitation follow-up period. Read More

Handb Clin Neurol 2012 ;109:149-66

Department of Neurology, Washington University, St. Louis, MO, USA.

In the past quarter century, spinal cord injury medicine has welcomed the proliferation of new medications and technologies that improve the survival and quality of life for people with spinal cord injury, but also endured the failure of strategies we hoped would salvage the cord in the acute phase. Surgical decompression and spinal stabilization should be pursued whenever indicated and feasible; however, there is no compelling evidence that early decompression facilitates neurological improvement. Methylprednisolone, the subject of over two decades of trials, has proven to be of marginal benefit in improving functional outcome. Read More

Gen Thorac Cardiovasc Surg 2013 Apr 20;61(4):191-6. Epub 2012 Oct 20.

First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamastu, Shizuoka, 431-3192, Japan.

During the last decade, treatment paradigm for degenerative aortic arch aneurysms has been changed by a better understanding of the pathophysiology of brain complication and introduction of endovascular technologies. To avoid neurocognitive dysfunction, safe duration of deep hypothermic circulatory arrest is now considered <25 min, and retrograde cerebral perfusion became less frequently used. Selective cerebral perfusion (SCP) is not associated with neurocognitive decline unless profound hypothermia (<20 °C) is used, which may suggest profound hypothermic SCP is not advantageous but may be detrimental. Read More

Rev Col Bras Cir 2012 ;39(1):16-21

Faculdade de Medicina, Universidade de Brasília, DF, Brazil.

Objective: To evaluate the data on the use of vena cava filter in the Division of Trauma, UCSD Medical Center - San Diego, CA / USA.

Methods: A descriptive study was conducted at the Division of Trauma to evaluate the cumulated experience and the therapeutic approach in patients attended by the staff of the Division of Trauma and submitted to placement of a vena cava filter as a method of prevention or treatment of Pulmonary Thromboembolism (PTE) from January 1999 to December 2008.

Results: The study comprised 512 patients, mostly males (73%). Read More

PM R 2012 Jan;4(1):11-7

Feinberg Medical School and The Rehabilitation Institute of Chicago, Northwestern University, Room 1154, 345 E. Superior, Chicago, IL 60611, USA.

Objective: To compare the safety and efficacy of 3 low-molecular-weight heparin (LMWH) treatments (enoxaparin, 40 mg once daily, with an alternative LMWH, tinzaparin, 3500 or 4500 units once daily) for the prevention of venous thromboembolic events (VTEs) after acute spinal cord injury (SCI).

Design: Retrospective, chart review study.

Setting: Acute inpatient rehabilitation facility. Read More

Plast Reconstr Surg 2011 Dec;128(6):1230-5

University of California Irvine Medical Center, CA, USA.

Background: The purpose of this study was to investigate the incidence of postoperative venous thromboembolism in chronic spinal cord injury patients undergoing plastic and reconstructive surgery. Previous studies show a venous thromboembolism incidence of 9.3 percent; however, based on anecdotal evidence, the authors hypothesize that the incidence is actually much lower. Read More

Crit Care Clin 2011 Oct;27(4):781-804, v

Department of Surgery, Carolinas Medical Center, Charlotte, NC 28232, USA.

Anticoagulation has been proven to be effective in preventing and treating deep vein thrombosis and pulmonary embolus. However, many critically ill patients are unable to receive anticoagulation or suffer recurrent venous thromboembolism despite adequate treatment. This article examines the use of vena cava filters in the critically ill. Read More

Am J Orthop (Belle Mead NJ) 2011 May;40(5):E83-7

Hospital of the University of Pennsylania, Philadelphia, USA.

Objectives: This study was designed to determine the outcome of implemented guidelines for venous thromboembolism (VTE) prophylaxis.

Methods: This study was a retrospective review of a series of consecutive blunt orthopaedic trauma patients with thromboembolic complications. The patients were compared to control subjects over the same 10-year period. Read More

PM R 2010 Jul;2(7):647-63

Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 325 Eisenhower, Suite 200, Ann Arbor, MI 48108, USA.

Venous thromboembolism (VTE) is a disease entity that encompasses both deep venous thrombosis and pulmonary embolism. During the past decade there have been significant advances in the understanding of prophylaxis and treatment of VTE. There is an extensive research base from which conclusions can be drawn, but the heterogeneity within the rehabilitation patient population makes the development of rigid VTE protocols challenging and overwhelming for the busy clinician. Read More

Am Surg 2010 Jun;76(6):563-70

Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA.

Venous thromboembolic disease is a significant source of morbidity and mortality in hospitalized trauma patients. Multiple drugs and dosing regimens have been suggested for pharmacoprophylaxis. In this study, we compared efficacy, complications, and cost of unfractionated heparin administered subcutaneously three times a day with standard-dosed enoxaparin for prophylaxis of deep venous thrombosis (DVT) in adult trauma patients over 1 year. Read More

J Bone Joint Surg Am 2010 Feb;92(2):304-13

Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53792, USA.

Background: Venous thromboembolic disease, including deep venous thrombosis and pulmonary embolism, is a serious and potentially life-threatening complication following orthopaedic surgical procedures. We sought to investigate the prevalence of thromboembolism as well as the efficacy and complications of various prophylactic measures in a population of patients who had undergone elective spine surgery.

Methods: A meta-analysis and univariate logistic regression were performed on selected studies to determine the prevalence of and risk factors for deep venous thrombosis and pulmonary embolism following elective spine surgery. Read More

Neurocrit Care 2010 Apr;12(2):297-309

Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA.

Venous thrombo-embolism (VTE) is frequently encountered in critically ill neurological and neurosurgical patients admitted to intensive care units. This patient population includes those with brain neoplasm, intracranial hemorrhage, ischemic stroke, subarachnoid hemorrhage, pre- and post-operative patients undergoing neurosurgical procedures and those with traumatic brain injury, and acute spinal cord injury (SCI). There is a wide variability in clinical practice for thromboprophylaxis in these patients, in part due to paucity of data based on randomized clinical trials. Read More

J Clin Neurosci 2010 Jan 13;17(1):142-4. Epub 2009 Nov 13.

Department of Neurosurgery, Royal Melbourne Hospital, Grattan Street, Parkville Victoria 3050, Australia.

Spontaneous spinal epidural haematoma (SSEH) is a rare cause of spinal cord compression in adults, especially in the elderly. We report an independent 88-year-old female, on aspirin only for chronic atrial fibrillation, who presented with a 12-hour history of acute lumbar back pain, urinary incontinence and progressive bilateral lower limb paresis. Examination revealed saddle anaesthesia and reduced anal tone. Read More

J Bone Joint Surg Am 2009 Nov;91(11):2568-76

Department of Orthopaedics, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.

Background: The increased risk for venous thromboembolic events following spinal trauma is well established. The purpose of the present study was to examine the literature in order to determine the optimum thromboprophylaxis regimen for patients with acute spinal injuries with or without spinal cord injury.

Methods: EMBASE, MEDLINE, and Cochrane databases were searched from the earliest available date to April 2008 for clinical trials comparing different methods of thromboprophylaxis in adult patients following acute spinal injuries (with or without spinal cord injury). Read More

Thromb Res 2010 Jun 23;125(6):501-4. Epub 2009 Oct 23.

Department of Neurological Rehabilitation, the Chaim Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel.

Unlabelled: Venous thromboembolism (VTE) is a well-recognized complication of Acute Traumatic Spinal Cord Injury (ATSCI). Despite prophylaxis by heparins, VTE occurs in a substantial number of ATSCI patients without an obvious explanation. In this matched case-control study we examined whether thrombophilia and other risk factors are associated with failure of thromboprophylaxis. Read More

Thromb Res 2009 Nov 30;124(5):e26-31. Epub 2009 Jul 30.

Dipartimento di Medicina Clinica, Università dell'Insubria, Varese, Italy.

Neurological disorders are often associated with immobilization, thus placing patients at increased risk for venous thromboembolism (VTE). This risk is very high in patients with acute ischemic stroke and spinal cord injuries, and it remains poorly defined in patients with peripheral nervous disorders or degenerative disorders of the central nervous system. The benefit of prophylactic strategies remains often unclear. Read More

Spine J 2009 Jul 28;9(7):530-6. Epub 2009 Feb 28.

Department of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA.

Background Context: Although there are several studies evaluating the necessity and efficacy of thromboprophylaxis after spinal trauma with or without spinal cord injury (SCI), to date there is no established standard of practice pertaining to this specific patient population with regards to venous thromboembolism (VTE) prophylaxis.

Purpose: To reach a consensus opinion in the administration of thromboprophylaxis in both preoperative and postoperative care in the settings of spinal trauma and SCI.

Study Design: A live survey on thromboprophylaxis after spinal surgery in the setting of trauma was conducted at a meeting among spine trauma surgeons. Read More

Arch Phys Med Rehabil 2009 Feb;90(2):232-45

Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.

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. Read More

Am J Phys Med Rehabil 2009 Jul;88(7):587-90

Spinal Rehabilitation Unit, AF Institute of Rehabilitation Medicine, Rawalpindi, Pakistan.

Case series of pressure ulcers in patients with spinal cord injury after inappropriate and prolonged application of graduated compression stockings are presented. Three adult patients with spinal cord injury were fitted with graduated compression stockings in the acute phase to prevent thromboembolism. Acute hospital staff did not monitor the skin for potential pressure ulcer because of the graduated compression stockings. Read More

J Am Acad Orthop Surg 2008 Nov;16(11):656-64

Southern Orthopaedic Surgeons, Montgomery, AL 36116, USA.

Venous thromboembolism is a life-threatening adverse event in spine patients and presents difficult decisions for the surgeon and patient. Prophylactic protocols have been established to prevent the occurrence of venous thromboembolism and its sequelae, including venous occlusion, edema, postthrombotic syndrome, and death. Despite the known benefits of prophylaxis, some surgeons choose not to use it because of concerns over increased bleeding complications and possible iatrogenic neurologic injury. Read More

J Spinal Cord Med 2008 ;31(4):379-87

Division of Physical Medicine and Rehabilitation, Dalhousie University, Nova Scotia Rehabilitation Centre, Department of Medicine, Halifax, Nova Scotia, Canada.

Background: When venous thromboembolism (VTE) includes deep-vein thrombosis (DVT) and pulmonary embolism (PE), patients with acute traumatic spinal cord injury (SCI) have the highest incidence of VTE among all hospitalized groups, with PE the third most common cause of death. Although low-molecular-weight heparin (LMWH) outperforms low-dose unfractionated heparin (LDUH) in other patient populations, the evidence in SCI remains less robust.

Objective: To determine whether the efficacy for LMWH shown in previous SCI surveillance studies (eg, routine Doppler ultrasound) would translate into real-world effectiveness in which only clinically evident VTE is investigated (ie, after symptoms or signs present). Read More

Chest 2008 Jun;133(6 Suppl):381S-453S

Scripps Clinic, La Jolla, CA.

This article discusses the prevention of venous thromboembolism (VTE) and is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do or do not outweigh risks, burden, and costs. Grade 2 suggestions imply that individual patient values may lead to different choices (for a full discussion of the grading, see the "Grades of Recommendation" chapter by Guyatt et al). Read More

Thromb Haemost 2008 May;99(5):978-80

J Trauma 2007 Oct;63(4):764-9

Departments of Surgery and Medicine, University of Vermont College of Medicine, Burlington, Vermont, USA.

Background: Vena cava filters (VCFs) have been advocated for prophylaxis of pulmonary embolism in trauma patients at high risk for venous thrombosis in whom anticoagulation is contraindicated or not feasible. We sought to determine the frequency of VCF insertion and patterns of use in trauma patients using a large database.

Methods: Retrospective analysis of data from the National Trauma Data Bank of the American College of Surgeons on patients over the age of 17 years from 1991 to 2002. Read More

J Trauma 2007 May;62(5):1075-81; discussion 1081

Clinical Services Unit-Pharmaceutical Sciences, Department of Trauma Services, Vancouver Coastal Health Authority, Vancouver General Hospital, British Columbia, Canada.

Background: To compare the impact of switching from enoxaparin 30 mg subcutaneously (SC) twice daily to dalteparin 5,000 units SC once daily for venous thromboembolism (VTE) prophylaxis in critically-ill major orthopedic trauma and/or acute spinal cord injury (SCI) patients.

Methods: DETECT was a retrospective, cohort study at a tertiary care referral teaching center-phase 1 from December 1, 2002 to November 30, 2003 (enoxaparin); and phase 2 from January 1, 2004 to December 31, 2004 (dalteparin). Major orthopedic trauma patients with pelvic, femoral shaft, or complex lower extremity fractures, and/or acute SCI patients admitted to the intensive care unit and who received a low-molecular-weight heparin (LMWH) for VTE prophylaxis were included. Read More

Arch Phys Med Rehabil 2007 Mar;88(3 Suppl 1):S55-61

Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA.

Unlabelled: This self-directed learning module highlights the basic acute care management of traumatic and nontraumatic spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Acute traumatic SCI is optimally managed in a level 1 trauma center. Read More