Pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury: an Indian perspective

Study design: Prospective randomized single blind study. Objectives: To find out the incidence of deep vein thrombosis (DVT) in Indian acute spinal cord injury (ASCI) subjects with and without pharmacological prophylaxis. Setting: Indian Spinal Injuries Centre. Methods: Seventy four ASCI subjects were randomly divided into two groups with 37 subjects each: group I received no antithrombotic prophylaxis, and only physical measures like compression stockings were employed for prophylaxis, whereas group II received antithrombotic prophylaxis with low-molecular weight heparin (LMWH) along with physical measures as in group I. DVT was monitored through daily clinical assessment and doppler venous ultrasonography at 2 weeks. Results: Out of 37 subjects in each group, eight (21.6%) developed DVT in group I and two (5.4%) in group II. The difference was significant (P-value = 0.041). Six out of eight subjects who developed DVT in group I were asymptomatic. There was no incidence of significant DVT-related complications including pulmonary embolism in any of the subjects. Conclusions: There is a significant incidence of DVT in Indian subjects with ASCI but definitely less than what has been reported in western literature. Pharmacological prophylaxis (LMWH in this study) significantly (P = 0.041) decreases the incidence of DVT in subjects with ASCI. As there was no difference in the incidence of symptomatic DVT or related complications, a larger study would be required to conclude definitely on the role of pharmacological prophylaxis in the Indian population.