This handout is for spinal-cord-injury dvt/vte (highest-risk; lmwh within 24-72 h, ipc adjunct, no routine ivc filter). Your care team identified this based on: acute traumatic or non-traumatic sci within the first ~3 months — prophylaxis-decision pathway triggered (vte risk among the highest of any condition).
Other reasons your team may use this plan: new unilateral lower-limb swelling/warmth in an sci patient — dvt despite absent pain (sensory level abolishes the classic symptom); unexplained tachypnoea, hypoxaemia, tachycardia or new autonomic dysreflexia in an sci patient — occult pulmonary embolism until excluded; surveillance compression ultrasound detecting proximal dvt in an acute sci patient — route to sci-specific treatment + duration logic.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| enoxaparin (prophylactic) | 40 mg SC daily (renal/weight-adjusted; 30 mg SC daily if CrCl <30), start 24-72 h post-injury once haemostasis secured | SC | daily for ~8-12 weeks (longer if persistently immobile/complete motor injury) | Consortium for Spinal Cord Medicine CPG + ACCP/CHEST 2021 — LMWH is the prophylactic agent of choice in acute SCI; early initiation captures the day 7-14 risk peak |
| enoxaparin (therapeutic) | 1 mg/kg SC BID (1 mg/kg SC daily if CrCl <30) | SC | BID for confirmed VTE; ≥3 months then reassess | ASH 2020 (PMID 33007077); ACCP/CHEST 2021 — therapeutic LMWH for confirmed VTE; predictable SC absorption; reconcile timing with spinal-surgery bleeding window |
| Intermittent pneumatic compression (IPC) | Apply from admission; sole modality if pharmacologic prophylaxis contraindicated | N/A | continuous while immobile | PVA CPG — IPC is a recommended adjunct from admission and the bridge when bleeding risk precludes LMWH; add LMWH as soon as bleeding risk acceptable |
| dabigatran / apixaban / rivaroxaban (treatment, selected stable patients) | standard DOAC VTE-treatment regimen once spinal-surgery bleeding window passed and no contraindication | PO | per agent | ACCP/CHEST 2021 — DOACs acceptable for VTE treatment in stable patients; defer until surgical bleeding risk acceptable; avoid in significant renal impairment / drug interactions |
| warfarin | 5 mg PO daily, target INR 2-3 after LMWH bridge | PO | daily; overlap LMWH ≥5 d and until INR ≥2 for ≥24 h | ACCP/CHEST 2021 standard alternative for long-term oral AC after LMWH bridge |
| heparin (UFH) | prophylactic 5000 U SC q8-12h, or therapeutic weight-based IV with aPTT/anti-Xa | SC/IV | per indication | Preferred when reversibility/short half-life needed around spinal surgery or in severe renal impairment; serial platelets for HIT |
| AVOID routine IVC filter for primary prophylaxis | AVOID prophylactic IVC filter; reserve retrievable filter for proven proximal VTE + absolute ongoing AC contraindication, and remove when AC feasible | N/A | N/A | PVA CPG reverses older routine-filter practice; PREPIC2 (PMID 25919526) — filters do not reduce recurrent VTE/mortality when AC is possible and add long-term complications |
| AVOID treatment-dose AC across an unsecured spinal column / active bleed | Defer therapeutic AC until haemostasis secured + spinal stabilisation timeline allows; use IPC bridge | N/A | N/A | Spinal epidural haematoma risk; reconcile AC timing with neurosurgery before therapeutic dosing |
Plan: SCI VTE — LMWH prophylaxis within 24-72 h of injury after haemostasis + IPC adjunct; therapeutic LMWH for confirmed VTE; ~8-12-week prophylaxis duration; routine IVC filter NOT recommended (Consortium for Spinal Cord Medicine; ACCP/CHEST 2021)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
SCI rehab + haematology co-management: complete the ~8-12-week prophylaxis course (extend if persistently immobile); for treated VTE complete ≥3-month course and reassess ongoing provoking risk; remove any retrievable IVC filter once AC feasible; reproductive counselling (oestrogen avoidance) for women; PTS surveillance; reconcile with the autonomic-dysreflexia plan (DVT is an AD trigger)
Guideline: Consortium for Spinal Cord Medicine — Prevention of VTE in SCI (PVA CPG) + ACCP/CHEST 2021 + ASH 2020 VTE Treatment