Michael G. Fehlings, Toronto Western Hospital; University of TorontoFollow
Lindsay A. Tetreault, Toronto Western Hospital; University College CorkFollow
Bizhan Aarabi, University of Maryland School of MedicineFollow
Paul Anderson, University of Wisconsin, MadisonFollow
Paul M. Arnold, The University of KansasFollow
Darrel S. Brodke, University of UtahFollow
Anthony S. Burns, Toronto Rehabilitation InstituteFollow
Kazuhiro Chiba, National Defense Medical College
Joseph R. Dettori, Spectrum Research, Inc
Julio C. Furlan, University of Toronto; Toronto Rehabilitation InstituteFollow
Gregory Hawryluk, University of Utah
Langston T. Holly, University of California at Los AngelesFollow
Susan Howley, Christopher & Dana Reeve Foundation
Tara Jeji, Ontario Neurotrauma Foundation
Sukhvinder Kalsi-RyanFollow
Mark Kotter, University of Cambridge
Shekar Kurpad, Medical College of WisconsinFollow
Brian K. Kwon, University of British ColumbiaFollow
Ralph J. Marino, Thomas Jefferson UniversityFollow
Allan R. Martin, Toronto Western HospitalFollow
Eric Massicotte, Toronto Western HospitalFollow
Geno J. Merli, Thomas Jefferson UniversityFollow
James W. Middleton, University of SydneyFollow
Hiroaki Nakashima, Nagoya University Graduate School of MedicineFollow
Narihito Nagoshi, Toronto Western Hospital; Keio University School of MedicineFollow
Katherine Palmieri, The University of KansasFollow
Anoushka Singh, Toronto Western HospitalFollow
Andrea C. Skelly, Spectrum Research, Inc
Eve C. Tsai, University of Ottawa
Alexander R. Vaccaro, Thomas Jefferson UniversityFollow
Jefferson R. Wilson, University of Toronto; St. Michael s HospitalFollow
Albert Yee, Sunnybrook Health Sciences CentreFollow
James Harrop, Thomas Jefferson UniversityFollow

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Publication Date



This article has been peer reviewed. It is the author’s final published version in Global Spine Journal

Volume 7, Issue 3 Supplement, September 2017, Pages 212S-220S.

The published version is available at DOI: 10.1177/2192568217702107. Copyright © Fehlings et al.


Introduction: The objective of this study is to develop evidence-based guidelines that recommend effective, safe and cost-effective thromboprophylaxis strategies in patients with spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions relating to thromboprophylaxis in SCI. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on conclusions from the systematic review and expert panel opinion, the following recommendations were developed: (1) “We suggest that anticoagulant thromboprophylaxis be offered routinely to reduce the risk of thromboembolic events in the acute period after SCI;” (2) “We suggest that anticoagulant thromboprophylaxis, consisting of either subcutaneous low-molecular-weight heparin or fixed, low-dose unfractionated heparin (UFH) be offered to reduce the risk of thromboembolic events in the acute period after SCI. Given the potential for increased bleeding events with the use of adjusted-dose UFH, we suggest against this option;” (3) “We suggest commencing anticoagulant thromboprophylaxis within the first 72 hours after injury, if possible, in order to minimize the risk of venous thromboembolic complications during the period of acute hospitalization.” Conclusions: These guidelines should be implemented into clinical practice in patients with SCI to promote standardization of care, decrease heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions. © 2017, © The Author(s) 2017.

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