T - VTE PROPHYLAXIS
T.1.1
Low-molecular-weight heparin may be used as thromboprophylaxis in the acute-care phase following SCI, once there is no evidence of active bleeding. (Adapted from CSCM 2016, p.220; Level C)
T.1.2
In patients whose low-molecular-weight heparin is delayed because of concerns about bleeding, a daily assessment of bleeding risk should be carried out. Low-molecular-weight heparin can be started when the bleeding risk decreases. (Adapted from CSCM 2016, p.220; Level C)
T.1.3
Combined mechanical methods of thromboprophylaxis (intermittent pneumatic compression devices with or without graduated compression stockings) and anticoagulant methods of thromboprophylaxis should be used particularly in the acute care phase, as soon as possible after injury, unless either option is contraindicated. (CSCM 2016, p.223; Level C)
T.1.4
Oral vitamin K antagonists (such as warfarin) should not be used as thromboprophylaxis in the early acute care phase following SCI. (Adapted from CSCM 2016, p.223; Level C)
T.1.5
Vena cava filters for select individuals who fail routine anticoagulation or are not candidates for anticoagulation and/or mechanical devices is recommended. (Adapted from CNS-DVT 2013, p.244; Level C)
T.1.6
We recommend against the use of low-dose or adjusted-dose unfractionated heparin in the prevention of VTE in SCI (unless low-molecular-weight heparin is not available or contraindicated). (CSCM 2016, p.222; Level B)
T.2.1
Individuals with SCI should not routinely be screened with doppler ultrasound for clinically inapparent DVT during their acute-care admission. (Adapted from CSCM 2016, p.227; Level B)
T.3.1
Duplex doppler ultrasound, impedance plethysmography, venous occlusion plethysmography, venography, and clinical examination are recommended as potential diagnostic tests for DVT in individuals with SCI. (Adapted from CNS-DVT 2013, p.244; Level C)
T.4.1
Anticoagulant thromboprophylaxis should continue for at least eight weeks after injury in individuals with limited mobility. (Adapted from CSCM 2016, p.224; Level C)
T.4.2
Direct oral anticoagulants may be considered as thromboprophylaxis during the rehabilitation phase. (Adapted from CSCM 2016, p.223; Level C)
T.4.3
One of the following options may be used as thromboprophylaxis in the post-acute rehabilitation phase: low-molecular-weight heparin, oral vitamin K antagonists (INR 2.0-3.0), or a direct oral anticoagulant. (CSCM 2016, p.224; Level C)
T.5.1
Individuals with chronic SCI who are hospitalized for medical illnesses or surgical procedures should receive thromboprophylaxis during the period of increased risk. (CSCM 2016, p.231; Level C)