TY - JOUR
T1 - A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury
T2 - Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis
AU - Fehlings, Michael G.
AU - Tetreault, Lindsay A.
AU - Aarabi, Bizhan
AU - Anderson, Paul
AU - Arnold, Paul M.
AU - Brodke, Darrel S.
AU - Burns, Anthony S.
AU - Chiba, Kazuhiro
AU - Dettori, Joseph R.
AU - Furlan, Julio C.
AU - Hawryluk, Gregory
AU - Holly, Langston T.
AU - Howley, Susan
AU - Jeji, Tara
AU - Kalsi-Ryan, Sukhvinder
AU - Kotter, Mark
AU - Kurpad, Shekar
AU - Kwon, Brian K.
AU - Marino, Ralph J.
AU - Martin, Allan R.
AU - Massicotte, Eric
AU - Merli, Geno
AU - Middleton, James W.
AU - Nakashima, Hiroaki
AU - Nagoshi, Narihito
AU - Palmieri, Katherine
AU - Singh, Anoushka
AU - Skelly, Andrea C.
AU - Tsai, Eve C.
AU - Vaccaro, Alexander
AU - Wilson, Jefferson R.
AU - Yee, Albert
AU - Harrop, James S.
N1 - Publisher Copyright:
© 2017, © The Author(s) 2017.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - 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.
AB - 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.
KW - acute spinal cord injury
KW - anticoagulant
KW - anticoagulant thromboprophylaxis
KW - guideline
KW - spinal cord injury
KW - thromboprophylaxis
KW - traumatic spinal cord injury
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U2 - 10.1177/2192568217702107
DO - 10.1177/2192568217702107
M3 - Article
AN - SCOPUS:85029049305
SN - 2192-5682
VL - 7
SP - 212S-220S
JO - Global Spine Journal
JF - Global Spine Journal
IS - 3_supplement
ER -