A patient with acute traumatic spinal cord injury may receive prophylactic heparin to prevent formation of thromboemboli. Rubin-Asher et al identified a number of risk factors associated with failure of heparin to prevent thromboemboli. The authors are from Chaim Sheba Medical Center, Tel-Aviv University and Kaplan Medical Center in Israel.


Patient selection: acute traumatic spinal cord injury

Thromboprophylaxis: with unfractionated or low molecular weight heparin


Risk factors for thromboemboli despite thromboprophylaxis:

(1) family history of venous thromboemboli

(2) prothrombin gene mutation G20210A

(3) elevation plasma levels of Factor VIII

(4) elevated plasma homocysteine concentration



• An additional risk factor might be a personal history of venous thromboembolism or failure of heparin prophylaxis.


A patient with one or more of these risk factors:

(1) may require a higher dose of heparin or alternative anticoagulant

(2) may require a longer course of anticoagulation

(3) may require placement of a vena caval filter


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