Prevention of Venous Thromboembolism in the Rehabilitation Phase after Spinal Cord Injury: Prophylaxis with Low-Dose Heparin or Enoxaparin

BACKGROUND: This prospective, multicenter study compared low-dose unfractionated heparin (UFH) with enoxaparin for prophylaxis against venous thromboembolism (VTE) during the rehabilitation phase after spinal cord injury. METHODS: After 2 weeks of acute-phase prophylaxis, patients without objective evidence of VTE entered the rehabilitation phase and received up to 6 additional weeks of thromboprophylaxis with either UFH 5,000 U every 8 hours or enoxaparin 40 mg once daily. Patients then underwent repeat bilateral lower extremity duplex ultrasonography. RESULTS: Among 119 patients who completed the rehabilitation phase and had adequate imaging, new VTE was demonstrated in 13 of 60 UFH versus 5 of 59 enoxaparin patients (21.7% vs. 8.5%; p = 0.052). Only one patient from each group was discontinued from the study because of bleeding. CONCLUSION: In this nonrandomized comparison, enoxaparin appeared more effective than heparin in the prevention of thromboembolic complications during rehabilitation after spinal cord injury. Both interventions were safe in this population.