Retrospective, chart review study.
SETTING: Acute inpatient rehabilitation facility.
PARTICIPANTS: A total of 140 participants who met inclusion criteria were admitted at a median of 15 days after an acute SCI. Before admission to rehabilitation, 23.6% were not on any VTE prophylaxis, 55.7% were on
enoxaparin, 17.1% were on
unfractionated heparin, 1.4% were on treatment doses of a
LMWH, and 2.1% did not have documentation available regarding type of prophylaxis before admission. No patients were receiving
tinzaparin before admission. During rehabilitation, 68 participants received prophylaxis with
enoxaparin, whereas 14 and 58 participants received
tinzaparin 3500 or 4500 units, respectively. Symptomatic VTE developed in 14 patients during rehabilitation, including 4 developing pulmonary emboli. Compared with patients receiving
tinzaparin 3500 units, both those receiving
enoxaparin had significantly reduced odds of VTE (odds ratio [OR] 0.12; 95% confidence interval [95% CI] 0.02-0.65)] and those receiving
tinzaparin 4500 units had significantly reduced odds of VTE (OR 0.18; 95% CI 0.03-0.93). After we adjusted for age, previous pharmacologic prophylaxis, and etiology for the SCI (traumatic vs nontraumatic) via propensity scores, pharmacologic prophylaxis with
enoxaparin remained protective for VTE compared with
tinzaparin 3500 units (adjusted OR 0.15; 95% CI 0.02-0.93). The use of prophylaxis before admission with
enoxaparin compared with no prophylaxis was associated with decreased risk of VTE during rehabilitation (adjusted OR 0.20; 95% CI 0.04-0.88); however, this association was no longer significant when we adjusted for prophylaxis during rehabilitation. The etiology for the SCI and the presence of an
inferior vena cava filter were not associated with VTE. One patient receiving
enoxaparin required transfer for a
bleeding event, and no patients had greater than a 1-g decrease in
hemoglobin during the rehabilitation stay.
CONCLUSIONS: VTE was more prevalent in participants receiving
tinzaparin 3500 units than in participants who received
tinzaparin 4500 units or
enoxaparin.
Bleeding events were low with the use of
LMWH for prophylaxis during acute rehabilitation. Although the use of prophylaxis before rehabilitation may be protective of VTE events, after we adjusted for VTE prophylaxis during rehabilitation, type of previous prophylaxis was not found to be significantly protective of VTE events during rehabilitation.