Anticoagulation

Persons with SCI are designated as a population at high risk for blood clot formation because immobilization after SCI often causes venous stasis leading to hypercoagulability and possibly life-threatening complications such as deep vein thrombosis and pulmonary embolism.²⁹ Thus, anticoagulative prophylaxis with subcutaneous low-molecular-weight heparin (LMWH) is the standard of care after SCI.

The LMWH is usually accompanied by mechanical prophylaxis that includes use of compression stockings and intermittent pneumatic compression.^14,29 In cases wherein there is a heightened bleeding risk, mechanical measures can be used without pharmacological intervention. It is recommended to implement LMWH therapy as soon as possible after SCI and for at least 12 weeks, with brief interruption for necessary surgery.^14,29 Unfractionated heparin is an alternative if LMWH cannot be used, but evidence indicates lower efficacy.¹⁴ Treatment with warfarin or direct anticoagulants is not recommended for acute SCI because of the heightened bleeding risk.¹⁴