Prevention of Venous Thromboembolism in the Acute Treatment Phase after Spinal Cord Injury: A Randomized, Multicenter Trial Comparing Low-Dose Heparin Plus Intermittent Pneumatic Compression with Enoxaparin

BACKGROUND: The risk of venous thromboembolism is high after spinal cord injury (SCI). This prospective, multicenter study compared unfractionated heparin (UFH) plus intermittent pneumatic compression (IPC) to enoxaparin alone as thromboprophylaxis after SCI. METHODS: Patients with acute SCI were randomly assigned to receive either UFH, 5,000 U every 8 hours, in combination with IPC or enoxaparin, 30 mg every 12 hours. Outcome measures were deep vein thrombosis, pulmonary embolism, and major bleeding after 2 weeks of prophylaxis. RESULTS: Among 107 assessable patients, the incidence of venous thromboembolism was 63.3% with UFH-IPC versus 65.5% with enoxaparin (p = 0.81). The incidence of PE was 18.4% with UFH-IPC versus 5.2% with enoxaparin (p = 0.03). Among all randomized patients, the incidence of major bleeding was 5.3% with UFH-IPC versus 2.6% with enoxaparin (p = 0.14). CONCLUSION: In the acute treatment phase after SCI, safety and thromboprophylactic efficacy were generally similar with UFH-IPC and enoxaparin.