Spine Trauma

1. Enoxaparin 30mg twice daily remains the recommended dosing.

2. Prior to starting chemical VTE prophylaxis, consult a spine surgeon.

3. Patients with traumatic spine injury or who undergo spine surgery should have VTE prophylaxis initiated within 48-72 hours after injury or after spine surgery.

a. Chemical VTE prophylaxis initiated within 48 hours of operative fixation of traumatic spine fractures does not increase the risk of bleeding, progression of neurological injury, or postoperative complications including spinal hematoma. 38

b. Delays longer than 72 hours lead to a substantial increase in VTE rate. 39

4. Patients with suspected traumatic spinal injury and neurologic deficits should have chemical VTE prophylaxis held until imaging and spinal surgical consultation are obtained.