Meta-Analysis Investigating Optimal Timing of Chemoprophylaxis for Venous Thromboembolism in Operatively Managed Blunt Spinal Injuries

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Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram showing literature search.
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Forest plots showing (A) deep venous thrombosis, (B) mortality, (C) overall venous thromboembolism, and (D) pulmonary embolism.

Table 1

Characteristics of the included studies.

Study	Study Design	No. of Patients	Age, y, median	Period	VTE Prophylaxis Timing Definition		Inclusion Criteria of Study
Study	Study Design	No. of Patients	Age, y, median	Period	Early	Late	Inclusion Criteria of Study
Hamidi, 20209	Retrospective cohort analysis	526	46 ± 22 y	2014–2017	≤48 h	>48 h	Adult patients (≥18 y old) with trauma with any isolated spinal trauma (extraspinal abbreviated injury scale <3) who were managed operatively and received chemical thromboprophylaxis with LMWH.
Zeeshan, 201810	Retrospective clinical trial	3554	34.8 ± 20.9	2013–2014	<48 h	>48 h	Adult patients (>18 y old) with isolated spine injury and diagnosed vertebral fracture who received LMWH and underwent operative intervention.
Aito, 200211	Prospective clinical trial	275	Early: 41.3 Late: 42.3	1 January 1996 to 15 May 2000	Within 72 h	7–28 d postinjury (mean 12 d)	All acute traumatic BSI patients consecutively admitted with motor complete and incomplete lesions. Absence of contraindications to heparin and/or mechanical prophylaxis.

Table 2

Design and clinical characteristics of included studies.

Study	No. of Patients by Prophylaxis Timing		Type of PTP	Dose of VTEP	Additional Prophylaxis	Median GCS	Trauma ISS
Study	Early	Late	Type of PTP	Dose of VTEP	Additional Prophylaxis	Median GCS	Trauma ISS
Hamidi, 20209	332	194	LMWH	Not mentioned	No	Early: 15 (14–15), Late: 15 (14–15)	Early: 13 (10–17), Late: 15 (9–27)
Zeeshan, 201810	1772	1772	LMWH	Not mentioned	Unfractionated heparin	15	14
Aito, 200211	99	176	LMWH	Not mentioned	Mechanical prophylaxis	Not mentioned	Not mentioned

Abbreviations: GCS, Glasgow Coma Scale; ISS, injury severity scale; LMWH, low molecule weight heparin; PTP, pharmacotherapy prophylaxis; VTEP, venous thromboembolism prophylaxis.