- Frank intracranial bleeding
- Incomplete SCI with perispinal bleeding
- Active major bleeding or very high bleeding risk
- Mechanical thromboprophylaxis only.
- If high bleeding risk resolves, add LMWH
- Begin LMWH (40 mg sc daily) +/- mechanical prophylaxis acutely.
- In the inpatient rehabilitation phase, can choose LMWH, warfarin (INR 2-3), or direct oral anticoagulant.
- Continue thromboprophylaxis at least 8 weeks and while admitted to inpatient rehabilitation.
- Chronic SCI patients should receive thromboprophylaxis during time period of increased risk.
Do not routinely screen with Doppler ultrasound for clinically inapparent DVT on admission to rehabilitation.
Consortium for spinal cord medicine. Prevention of venous thromboembolism in individuals with spinal cord injury. Clinical practice guidelines, Paralyzed veterans of America 2016(3rd edition).
Kirshblum S, Nieves J, Clark D, Gonzalez P, Cuccurullo SJ, Luciano L. Physical Medicine and Rehabilitation Board Review. Cuccurullo SJ LJ, editor. 3 rd ed. New York, NY: Demos Medical; 2015. Chapter 7, Spinal cord injuries. p.551-620.