Spinal Cord Series and Cases, 2019 · DOI: 10.1038/s41394-019-0180-1 · Published: March 19, 2019
This report discusses the risk of blood clots in patients with spinal cord injuries, which is higher right after the injury. Doctors often prescribe blood thinners to prevent these clots, but it's not always clear how long the treatment should last, especially for patients with long-term injuries. The authors present two cases where patients with chronic spinal cord injuries developed large hematomas (collections of blood) in their buttocks while taking a common blood thinner called enoxaparin to prevent blood clots. The authors suggest that doctors might be overprescribing blood thinners to spinal cord injury patients, exposing them to unnecessary risks like bleeding. They emphasize the need for more research to better estimate the risk of blood clots in these patients and to determine the appropriate duration of preventive treatment.
Current guidelines may need to be revised to address the specific needs of chronic SCI patients, considering the potential for overestimation of VTE risk.
Clinicians should conduct individualized risk assessments rather than relying solely on plegia when deciding on VTE prophylaxis for SCI patients.
Reducing prophylactic VTE treatment could be a starting point for reducing polypharmacy in SCI patients, given the potential for overestimation of VTE risk.