A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury

Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis

Michael G. Fehlings, Lindsay A. Tetreault, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K. Kwon, Ralph J. Marino, Allan R. Martin & 13 others Eric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander Vaccaro, Jefferson R. Wilson, Albert Yee, James S. Harrop

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Introduction: The objective of this study is to develop evidence-based guidelines that recommend effective, safe and cost-effective thromboprophylaxis strategies in patients with spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions relating to thromboprophylaxis in SCI. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on conclusions from the systematic review and expert panel opinion, the following recommendations were developed: (1) “We suggest that anticoagulant thromboprophylaxis be offered routinely to reduce the risk of thromboembolic events in the acute period after SCI;” (2) “We suggest that anticoagulant thromboprophylaxis, consisting of either subcutaneous low-molecular-weight heparin or fixed, low-dose unfractionated heparin (UFH) be offered to reduce the risk of thromboembolic events in the acute period after SCI. Given the potential for increased bleeding events with the use of adjusted-dose UFH, we suggest against this option;” (3) “We suggest commencing anticoagulant thromboprophylaxis within the first 72 hours after injury, if possible, in order to minimize the risk of venous thromboembolic complications during the period of acute hospitalization.” Conclusions: These guidelines should be implemented into clinical practice in patients with SCI to promote standardization of care, decrease heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.

Original languageEnglish
Pages (from-to)212S-220S
JournalGlobal Spine Journal
Volume7
Issue number3_supplement
DOIs
Publication statusPublished - 2017 Sep 1

Fingerprint

Practice Management
Spinal Cord Injuries
Practice Guidelines
Anticoagulants
Heparin
Guidelines
Low Molecular Weight Heparin
Expert Testimony
Hospitalization
Hemorrhage
Costs and Cost Analysis
Wounds and Injuries

Keywords

  • acute spinal cord injury
  • anticoagulant
  • anticoagulant thromboprophylaxis
  • guideline
  • spinal cord injury
  • thromboprophylaxis
  • traumatic spinal cord injury

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury : Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis. / Fehlings, Michael G.; Tetreault, Lindsay A.; Aarabi, Bizhan; Anderson, Paul; Arnold, Paul M.; Brodke, Darrel S.; Burns, Anthony S.; Chiba, Kazuhiro; Dettori, Joseph R.; Furlan, Julio C.; Hawryluk, Gregory; Holly, Langston T.; Howley, Susan; Jeji, Tara; Kalsi-Ryan, Sukhvinder; Kotter, Mark; Kurpad, Shekar; Kwon, Brian K.; Marino, Ralph J.; Martin, Allan R.; Massicotte, Eric; Merli, Geno; Middleton, James W.; Nakashima, Hiroaki; Nagoshi, Narihito; Palmieri, Katherine; Singh, Anoushka; Skelly, Andrea C.; Tsai, Eve C.; Vaccaro, Alexander; Wilson, Jefferson R.; Yee, Albert; Harrop, James S.

In: Global Spine Journal, Vol. 7, No. 3_supplement, 01.09.2017, p. 212S-220S.

Research output: Contribution to journalArticle

Fehlings, MG, Tetreault, LA, Aarabi, B, Anderson, P, Arnold, PM, Brodke, DS, Burns, AS, Chiba, K, Dettori, JR, Furlan, JC, Hawryluk, G, Holly, LT, Howley, S, Jeji, T, Kalsi-Ryan, S, Kotter, M, Kurpad, S, Kwon, BK, Marino, RJ, Martin, AR, Massicotte, E, Merli, G, Middleton, JW, Nakashima, H, Nagoshi, N, Palmieri, K, Singh, A, Skelly, AC, Tsai, EC, Vaccaro, A, Wilson, JR, Yee, A & Harrop, JS 2017, 'A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis', Global Spine Journal, vol. 7, no. 3_supplement, pp. 212S-220S. https://doi.org/10.1177/2192568217702107
Fehlings, Michael G. ; Tetreault, Lindsay A. ; Aarabi, Bizhan ; Anderson, Paul ; Arnold, Paul M. ; Brodke, Darrel S. ; Burns, Anthony S. ; Chiba, Kazuhiro ; Dettori, Joseph R. ; Furlan, Julio C. ; Hawryluk, Gregory ; Holly, Langston T. ; Howley, Susan ; Jeji, Tara ; Kalsi-Ryan, Sukhvinder ; Kotter, Mark ; Kurpad, Shekar ; Kwon, Brian K. ; Marino, Ralph J. ; Martin, Allan R. ; Massicotte, Eric ; Merli, Geno ; Middleton, James W. ; Nakashima, Hiroaki ; Nagoshi, Narihito ; Palmieri, Katherine ; Singh, Anoushka ; Skelly, Andrea C. ; Tsai, Eve C. ; Vaccaro, Alexander ; Wilson, Jefferson R. ; Yee, Albert ; Harrop, James S. / A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury : Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis. In: Global Spine Journal. 2017 ; Vol. 7, No. 3_supplement. pp. 212S-220S.
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AU - Tetreault, Lindsay A.

AU - Aarabi, Bizhan

AU - Anderson, Paul

AU - Arnold, Paul M.

AU - Brodke, Darrel S.

AU - Burns, Anthony S.

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