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Comparison of two pharmacological prophylaxis strategies for venous thromboembolism in spinal cord injury patients: a retrospective study

Abstract

Study design

Retrospective cohort study.

Objective

To compare the cost and incidence of venous thromboembolism (VTE) and bleeding between two different VTE pharmacological prophylaxis strategies in individuals with spinal cord injury: one based on motor impairment (Protocol 1) and the other based on time from the lesion and presence of associated risk factors for VTE (Protocol 2).

Setting

A tertiary rehabilitation hospital in Brazil.

Methods

We retrospectively reviewed a total of 1475 charts of individual admissions: 814 individuals received pharmacological prophylaxis according to Protocol 1 and 661 according to protocol 2. These cohorts were compared with respect to age, time and level of injury, length of stay, AIS classification, type of injury, and occurrence of VTE and major bleeding. The number of prescribed doses of enoxaparin and expenditures associated with enoxaparin during each period were evaluated.

Results

The median lesion time was 3 years. The risk-based strategy drastically reduced the average monthly use of enoxaparin by 75% and the 12-month enoxaparin expenditure by $119,930.33, without increasing the risk of VTE. The incidence density of thromboembolic events was 0.55/10,000 patient-days, and all events occurred in individuals receiving prophylaxis according to Protocol 1.

Conclusions

Time from injury and risk of VTE-based protocol for indication of pharmacological prophylaxis drastically reduced costs. No difference in occurrence of VTE was observed.

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Acknowledgements

The authors gratefully acknowledge Mr. Alexandre Vasconcelos Lima, Ms. Lore Martins Bueno, and Mr. Mauro Cardoso for their valuable statistical consulting.

Author contributions

RLA was responsible for designing the study protocol, writing the protocol, conducting the chart search, extracting and analyzing data, interpreting results, updating reference lists, and drafting the final report. CCR was responsible for conducting the chart search, extracting and analyzing data, reviewing datasets, and writing the report. PSSB was responsible for designing the study protocol, reviewing the protocol, analyzing data, interpreting results, and providing feedback on the final report. CAMS was responsible for analyzing data, providing feedback on statistical methods, interpreting results, and providing feedback on the final report. VMA was responsible for reviewing the study protocol, analyzing data, interpreting results, updating reference lists, and reviewing the final report.

Author information

Statement of ethics

The present study was approved by the Associação das Pioneiras Sociais Ethics Committee (process number 1.581.383). We certify that all applicable institutional and governmental regulations concerning the ethical use of human health data were followed during the course of this research.

Conflict of interest

The authors declare that they have no conflict of interest.

Correspondence to Rodrigo Lanna de Almeida.

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