Article

The objective of this study is to systematically review and estimate
the effect of heparin for thromboprophylaxis in patients with acute spinal cord
injury (SCI).Methods:We searched the PubMed database up to February 2013. Only
randomized control trials (RCTs), quasi-RCTs, cohorts, case-control and
cross-sectional studies were included. The incidence of venous thromboembolism
(VTE) and major bleeding complication were recorded as the endpoints. The summary
relative risks (RR) were calculated by meta-analysis.Results:A total of 18
studies with 2578 patients were included. Four studies evaluated the effects of
low-dose unfractionated heparin (LDUH) compared placebo or untreated. No
significant differences were observed, with the summary RR 0.661 (95% confidence
interval (CI) 0.365-1.199; Z=1.36, P=0.173) for VTE. Only one RCT compared
fixed-dose LDUH with adjusted-dose LDUH, which showed lower VTE incidence but
higher bleeding incidence for adjusted dose. Nine trials have compared LDUH with
low-molecular-weight heparin (LMWH). No significant differences were observed for
VTE with the summary RR 1.633 (95% CI 0.822-3.243; Z=1.40,
P=0.162). But major
bleeding was lower with LMWH (summary RR=2.034, 95% CI 1.018-4.063; Z=2.01,
P=0.044). Three studies compared different LMWHs, which included one for
enoxaparin versus tinzaparin and two for enoxaparin versus dalteparin. No
significant differences were observed with the summary RR 0.694 (95% CI
0.336-1.434; Z=0.99, P=0.324) for VTE. Three studies compared different dose of
LMWH. No differences were observed.Conclusion:Our meta-analysis showed that in
patients with acute SCI, LDUH have no thromboprophylaxis effect compared with
placebo or untreated; LMWH seems only can reduce bleeding incidence, but not
prophylaxis thromboembolism compared with LDUH. Because of no good quality
studies existed in this setting, well-designed RCTs are urgently needed.

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