A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the type and timing of anticoagulant thromboprophylaxis

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dc.contributor.authorFehlings, Michael G.
dc.contributor.authorTetreault, Lindsay A.
dc.contributor.authorAarabi, Bizhan
dc.contributor.authorAnderson, Paul
dc.contributor.authorArnold, Paul M.
dc.contributor.authorBrodke, Darrel S.
dc.contributor.authorBurns, Anthony S.
dc.contributor.authorChiba, Kazuhiro
dc.contributor.authorDettori, Joseph R.
dc.contributor.authorFurlan, Julio C.
dc.contributor.authorHawryluk, Gregory
dc.contributor.authorHolly, Langston T.
dc.contributor.authorHowley, Susan
dc.contributor.authorJeji, Tara
dc.contributor.authorKalsi-Ryan, Sukhvinder
dc.contributor.authorKotter, Mark
dc.contributor.authorKurpad, Shekar
dc.contributor.authorKwon, Brian K.
dc.contributor.authorMarino, Ralph J.
dc.contributor.authorMartin, Allan R.
dc.contributor.authorMassicotte, Eric
dc.contributor.authorMerli, Geno
dc.contributor.authorMiddleton, James W.
dc.contributor.authorNakashima, Hiroaki
dc.contributor.authorNagoshi, Narihito
dc.contributor.authorPalmieri, Katherine
dc.contributor.authorSingh, Anoushka
dc.contributor.authorSkelly, Andrea C.
dc.contributor.authorTsai, Eve C.
dc.contributor.authorVaccaro, Alexander
dc.contributor.authorWilson, Jefferson R.
dc.contributor.authorYee, Albert
dc.contributor.authorHarrop, James S.
dc.contributor.funderAOSpine
dc.contributor.funderOntario Neurotrauma Foundation
dc.contributor.funderAmerican Association of Neurological Surgeons
dc.contributor.funderCongress of Neurological Surgeons
dc.contributor.funderGerald and Tootsie Halbert Chair in Neural Repair and Regeneration
dc.contributor.funderDeZwirek Family Foundation
dc.contributor.funderKrembil Foundation
dc.date.accessioned2018-03-09T12:55:06Z
dc.date.available2018-03-09T12:55:06Z
dc.date.issued2017
dc.description.abstractIntroduction: 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.en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationFehlings, M. G., Tetreault, L. A., Aarabi, B., Anderson, P., Arnold, P. M., Brodke, D. S., Burns, A. S., Chiba, K., Dettori, J. R., Furlan, J. C., Hawryluk, G., Holly, L. T., Howley, S., Jeji, T., Kalsi-Ryan, S., Kotter, M., Kurpad, S., Kwon, B. K., Marino, R. J., Martin, A. R., Massicotte, E., Merli, G., Middleton, J. W., Nakashima, H., Nagoshi, N., Palmieri, K., Singh, A., Skelly, A. C., Tsai, E. C., Vaccaro, A., Wilson, J. R., Yee, A. and Harrop, J. S. (2017) 'A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the type and timing of anticoagulant thromboprophylaxis', Global Spine Journal, 7(3S), pp. 212-220. doi: 10.1177/2192568217702107en
dc.identifier.doi10.1177/2192568217702107
dc.identifier.endpage220
dc.identifier.issn2192-5682
dc.identifier.issued3S
dc.identifier.journaltitleGlobal Spine Journalen
dc.identifier.startpage212
dc.identifier.urihttps://hdl.handle.net/10468/5597
dc.identifier.volume7
dc.language.isoenen
dc.publisherSage Publicationsen
dc.relation.urihttp://journals.sagepub.com/doi/10.1177/2192568217702107
dc.rights© 2017, the Authors. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/ ) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).en
dc.rights.urihttp://www.creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectAnticoagulant thromboprophylaxisen
dc.subjectAcute spinal cord injuryen
dc.subjectTraumatic spinal cord injuryen
dc.subjectSpinal cord injuryen
dc.subjectAnticoagulanten
dc.subjectThromboprophylaxisen
dc.subjectGuidelineen
dc.titleA clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the type and timing of anticoagulant thromboprophylaxisen
dc.typeArticle (peer-reviewed)en
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