Virtually all of the research to date has focused on the prevention of venous thromboembolism but there has been focus on the treatment of newly diagnosed venous thromboembolism in SCI.  The standard treatment is anticoagulation, generally with intravenous unfractionated heparin immediately followed by a gradual transition to Coumadin which is generally maintained for 3-6 months.   We were able to find one small study which compared UFH to LMWH.

Table: Unfractionated Heparin vs. LMW Heparin

Discussion

Again, there are remarkably few studies examining treatment of venous thrombolembolism post SCI with most of the research focus to date on prophylaxis. Tomaio et al. (1988) studied 6 SCI patients with acute DVT, half of whom were treated by IV Heparin followed by Warfarin and half who were treated by s/c enoxaparin followed by Warfarin.  Though the study was extremely small the author did a careful cost analysis.  S/C enoxaparin was regarded as a safe, cost-effective and less labour intensive treatment and could be of substantial benefit in the treatment of DVT in SCI patients. Obviously more research needs to be done.

Conclusions

• There is level 4 (limited) evidence that Enoxaparin subcutaneously appears to be a safe, cost-effective and less labour-intensive treatment than intravenous heparin for acute DVTs post SCI.

• Enoxaparin subcutaneously can be considered as an alternative to intravenous Heparin for acute DVTs post-SCI although more research needs to be done.