Dalteparin Vs Low-Dose Unfractionated Heparin for Prophylaxis Against Clinically Evident Venous Thromboembolism in Acute Traumatic Spinal Cord Injury: A Retrospective Cohort Study

J Spinal Cord Med, 2008 · DOI: · Published: January 1, 2008

Spinal Cord Injury Cardiovascular Science Pharmacology

Simple Explanation

Patients with acute traumatic spinal cord injuries are at high risk for developing venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Pulmonary embolism is a major cause of death in this population. This study compares the effectiveness of two types of blood thinners, low-molecular-weight heparin (LMWH) dalteparin and low-dose unfractionated heparin (LDUH), in preventing VTE in patients with spinal cord injuries, focusing on cases where VTE is clinically evident. The study found no significant difference between dalteparin and LDUH in preventing clinically evident VTE in patients with acute traumatic SCI. This suggests that LMWH may not be more effective than LDUH in this specific patient population.

Study Duration

9 Years

Participants

90 patients receiving LMWH dalteparin or LDUH for VTE prophylaxis after acute traumatic SCI

Evidence Level

Retrospective cohort study

Key Findings

1
There was no statistically significant difference in the incidence of VTE between patients receiving dalteparin and those receiving LDUH.
2
The location of DVT (proximal vs. distal) was not associated with the type of treatment received.
3
Paraplegia, as opposed to tetraplegia, was identified as a risk factor for VTE.

Research Summary

This retrospective cohort study compared the effectiveness of dalteparin and low-dose unfractionated heparin (LDUH) for preventing clinically evident venous thromboembolism (VTE) in patients with acute traumatic spinal cord injury (SCI). The study found no statistically significant difference in the incidence of VTE or complications between the two treatment groups, suggesting that dalteparin may not be more effective than LDUH in this population. The authors conclude that there is a continued lack of definitive evidence supporting the superiority of LMWH over LDUH for VTE prophylaxis in SCI patients and that novel approaches to VTE prevention are needed.

Practical Implications

Re-evaluate VTE Prophylaxis Strategies

The study suggests a need to re-evaluate current VTE prophylaxis strategies in acute traumatic SCI patients, as LMWH may not be superior to LDUH in this specific population.

Consider Paraplegia as a Risk Factor

Clinicians should consider paraplegia as a potential risk factor for VTE development in SCI patients when determining prophylactic measures.

Explore Novel Approaches

The lack of improvement in fatal PE rates over the past 25 years highlights the urgent need for novel VTE prophylaxis approaches tailored to patients with SCI.

Study Limitations

1
Retrospective cohort design introduces potential biases and limits causal inference.
2
Relatively small sample size (90 patients) may limit the power to detect significant differences.
3
Exclusion of patients due to delayed prophylaxis initiation or switching between heparin types may have introduced selection bias.

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