Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 2 , Pages 232-245, February 2009

Venous Thromboembolism After Spinal Cord Injury

  • Robert W. Teasell, MD, FRCPC

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
    • Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada
    • Corresponding Author InformationReprint requests to Robert W. Teasell, MD, FRCPC, Dept of Physical Medicine and Rehabilitation, Parkwood Hospital, Hobbins Building, Ste 404, 801 Commissioners Rd E, London, ON, Canada N6C 5J1
    • ,
  • Jane T. Hsieh, MSc

      Affiliations

    • Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada
    • ,
  • Jo-Anne L. Aubut, BA

      Affiliations

    • Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada
    • ,
  • Janice J. Eng, PhD

      Affiliations

    • Cardiovascular Physiology and Rehabilitation Laboratory, Experimental Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
    • Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
    • International Collaboration on Repair Discoveries, Vancouver, BC, Canada
    • ,
  • Andrei Krassioukov, MD, PhD, FRCPC

      Affiliations

    • Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
    • International Collaboration on Repair Discoveries, Vancouver, BC, Canada
    • Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
    • ,
  • Linh Tu, HonBHSc

      Affiliations

    • Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada
    • ,
  • Spinal Cord Injury Rehabilitation Evidence Review Research Team

Abstract 

Teasell RW, Hsieh JT, Aubut JL, Eng JJ, Krassioukov A, Tu L, for the Spinal Cord Injury Rehabilitation Evidence Review Research Team. Venous thromboembolism after spinal cord injury.

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.

Study Selection

Studies included RCTs, non-RCTS, cohort, case-control, case series, pre-post, and postinterventional studies. Case studies were included only when no other studies were available.

Data Extraction

Data extracted included demographics, the nature of the study intervention, and study results.

Data Synthesis

Levels of evidence were assigned to the interventions using a modified Sackett scale.

Conclusions

Twenty-three studies met inclusion criteria. Thirteen studies examined various pharmacologic interventions for the treatment or prevention of deep venous thrombosis in patients with SCI. There was strong evidence to support the use of low-molecular-weight heparin in reducing venous thrombosis events, and a higher adjusted dose of unfractionated heparin was found to be more effective than 5000 units administered every 12 hours, although bleeding complications were more common. Nonpharmacologic treatments were also reviewed, but again limited evidence was found to support these treatments.

Key Words: Rehabilitation, Spinal cord injuries, Venous thrombosis

List of Abbreviations: APTT, activated partial thromboplastin time, ASIA, American Spinal Injury Association, CT, computed tomography, DVT, deep venous thrombosis, IPC, intermittent pneumatic compression, IU, international units, IVC, inferior vena cava, LMWH, low-molecular-weight heparin, PE, pulmonary embolism, PEDro, Physiotherapy Evidence Database Scale, RCT, randomized controlled trial, s/c, subcutaneous, SCI, spinal cord injury, SCIRE, Spinal Cord Injury Rehabilitation Evidence Review, UFH, unfractionated heparin, VT, venous thrombosis

 

 Supported by the Ontario Neurotrauma Fund (grant no. 2007-SCI-SCIRE-528) and the Rick Hansen Man in Motion Foundation/International Collaboration on Repair Discoveries (ICORD) (grant no. Rick Hansen 2008-13).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(08)01564-5

doi:10.1016/j.apmr.2008.09.557

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 2 , Pages 232-245, February 2009

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