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

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Abstract
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. 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. 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. 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.