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Thread: Velmahos, et al. (2003). 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.

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    Velmahos, et al. (2003). 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.

    • Velmahos GC and Bednar MM (2003). 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. J Trauma 54:1116-26. Summary: 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.

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    • (2003). Prevention of Venous Thromboembolism in the Rehabilitation Phase after Spinal Cord Injury: Prophylaxis with Low-Dose Heparin or Enoxaparin. J Trauma 54:1111-1115. Summary: 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.

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