Venous thromboembolism management in acute traumatic spinal cord injury: Understanding practice patterns within SCI...

Area of Science:

• Medical Rehabilitation
• Neurology
• Vascular Medicine

Background:

• Traumatic spinal cord injury (tSCI) survivors face elevated risks of venous thromboembolism (VTE) during acute and sub-acute recovery.
• Current management strategies for VTE in tSCI patients lack uniformity, impacting patient outcomes.

Purpose of the Study:

• To investigate current practices for VTE prophylaxis, surveillance, and treatment among healthcare providers specializing in tSCI.
• To identify variations in diagnostic testing, anticoagulant use, and treatment durations for deep vein thrombosis (DVT) and pulmonary embolism (PE) in tSCI patients.

Main Methods:

• A cross-sectional online survey was administered to Spinal Cord Injury Model Systems (SCIMS) providers.
• The survey utilized a case scenario to assess management decisions regarding VTE in a patient with C6 ASIA Impairment Scale (AIS) A tetraplegia.

Main Results:

• Significant variability exists in ordering admission duplex scans, with over half of providers ordering them, but only 40% scanning both upper and lower limbs.
• Low molecular weight heparin (LMWH) is the predominant prophylactic agent, with enoxaparin being most common. Prophylaxis duration varied, with thirds of providers continuing for 8 or 12 weeks.
• Treatment for proximal DVT commonly involved LMWH followed by a direct oral anticoagulant (DOAC) or a DOAC alone, with most treatments lasting 3 months.

Conclusions:

• Practices for VTE diagnosis, prophylaxis, and treatment in tSCI patients are diverse across SCIMS centers.
• This heterogeneity underscores the critical need for robust research to develop updated, SCI-specific clinical guidelines for VTE management.