Are you still anticoagulating your acute SCI patients for different lengths based on the results of their AIS exam? If the answer is yes, forget the weeks associated with ASIA impairment scale and be ready to make your daily practice simplified. The Paralyzed Veterans of America just released new consortium guidelines for “Prevention of Venous Tromboembolism in Individuals with Spinal Cord Injury.” Check out the highlights below:
Length of Anticoagulation After SCI
New guidelines suggest:
Anticoagulation thromboprophylaxis continue for at least 8 weeks in individuals with SCI and limited mobility.
What does this mean for your practice? Because most DVTs occur within the first two weeks and rarely after 8 weeks, it makes sense to use anticoagulation thromboprophylaxis on your less mobile (probably most AIS A and B patients, some AIS C patients and probably few AIS D patients) patients.
Low molecular weight heparin
Type of Anticoagulation Used After SCI
is still the recommended drug of choice as well as other direct oral anticoagulants. Sorry unfractioned heparin, no endorsement from the PVA to expand your use. Warfarin is not recommended in the early care, but can be used in the post-acute care for VTE prophylaxis.
What About Those Socks and Compression Devices?
Both are recommended early and to be continued in the post-acute care if not contraindicated (leg injury, for example). These should be used along with anticoagulant thromboprophylaxis if not contraindicated.
Well, looks like just compression devices and stockings are recommended for kids, while adolescents should get VTE prophylaxis with low molecular weight heparin.
Ultrasound for DVT in SCI
We suggest that SCI patients not routinely be screened with Doppler ultrasonography (DUS) for clinically inapparent DVT during their acute–care admission.
We suggest that SCI patients not be routinely screened with DUS for clinically inapparent DVT on admission to rehabilitation.
Don’t keep your ultrasound techs too busy, as you should only obtain if the patient is clinically suspected of having a DVT and not for routine screening.
DVT Prophylaxis for Chronic SCI Patients Who are Admitted for Medical Illnesses
Basically, if you are consulted on an inpatient for SCI care, make sure they are on anticoagulation thromboprophylaxis, no matter how old the SCI injury.
Chen, D., MD, et al. “Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers.” Consortium for Spinal Cord Medicine Clinical Practice Guidelines (2016)