List Archives

Fri Aug 15 12:03:02 BST 2008

Patient with paraplegia/quadriplegia 
(FYI: from 2008 tetraplegia now internationally preferred/adopted
medical term)

As acute SCI aim is to commence LMWH within 24 hours of injury until
taking oral diet when preference is to warfarinise. All normal
contraindications apply. For EBP details access the Consortium for
Spinal Cord Medicine's best practice consensus guidelines on
thromboprophylaxis as a free pdf from:
http://www.pva.org/site/PageServer?pagename=pubs_main

This site also contains the 2008 guidelines for managing SCI in the
first 72 hours post-trauma.

Paul Harrison
Clinical Development Officer
Princess Royal Spinal Injuries Centre
Sheffield, UK

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of William Bromberg
Sent: 13 August 2008 19:16
To: 'Trauma &amp; Critical Care mailing list'
Subject: Outpatient VTE prophylaxis

Guys and Gals,

I am just trying to get a sense of the practice out there in terms of
outpatient DVT/PE prophylaxis after d/c from the trauma service. Let's
take some examples

1. Patient with multiple long bone/pelvic fractures who will be
non-weight-bearing for 6 weeks

2. Patient with long bone/pelvic fracture who will be NWB on one leg

3. Patient with long bone/pelvic fracture +/- other trauma (liver,
spleen, ptx, etc.) who will be limping but ambulatory

4. Patient with paraplegia/quadriplegia

Questions: 
a. Do you anticoagulate as an outpatient? 
b. With what? 
c. How long?

Our practice sadly varies but our basic answesr would be:

1. a.Yes. 
b. With LMWH if insured/can afford or coumadin (INR 2-2.5 if not). 
c.6 weeks

2. No - but I worry a lot.

3. No

4. a.Yes. 
b. LMWH. 
c. I don't know they all go to rehab. 

Thanks in advance!

Bill Bromberg
--
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Outpatient VTE prophylaxis