Thromboprophylaxis in Patients with Acute Spinal Cord Injury: A Narrative Review

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. The current thromboprophylaxis options are limited, with low-molecular-weight heparin (LMWH) being the current standard of care. LMWH is commonly administered for 3 months, during which period the risk of VTE is especially high. Some uncertainty exists regarding the optimal timing to initiate pharmacological thromboprophylaxis and the best regimen of LMWH prophylaxis. High-quality data are currently lacking in thromboprophylaxis in patients with SCI. Many questions in this area remain to be answered, which are described in this narrative review.