Deep vein thrombosis (DVT) and
pulmonary embolism (PE) are common life threatening complications of acute
myelopathy. Prophylaxis with low dose
unfractionated heparin (LDUH) has been the standard of care. Studies suggest that
low molecular weight heparin (
LMWH) has superior efficacy, but advantages may be offset by higher expense. Since
LMWH (
enoxaparin sodium) became available, standard practice at our institution has been to treat all inpatients with
myelopathy with
LMWH. To examine the impact of this practice, all inpatients diagnosed with
myelopathy and treated with
LMWH were sequentially matched by diagnosis and compared in a retrospective review with inpatients treated with LDUH. In each group, 11 patients had traumatic injury, four had
transverse myelitis, four had
neoplasms and five had
spinal stenosis. Characteristics of the
LMWH/LDUH groups were: mean age--48.5/50.4; spinal level--cervical 13/7, thoracic 9/12, lumbar 2/5; American
Spinal Injury Association impairment scale-A, 8/9;
B, 2/2; C, 8/5; D, 6/8. There were five DVTs and two PEs in five patients taking LDUH; there were no cases of DVT or of PE in the
LMWH group (p = 0.04, two-tailed chi-square test). Isolated DVTs occurred in two patients with traumatic
injuries and in one patient with
transverse myelitis; PE + DVT occurred in one patient with a primary and one patient with a metastatic
tumor. All developed within 3.5 months of the onset of spinal dysfunction. One patient with a traumatic injury on
ibuprofen and
dexamethasone had a
gastrointestinal hemorrhage while receiving
LMWH. The cost of administration of
LMWH was $24,499 compared with $5,700 for LDUH. The LDUH group spent a total of 57 days in an acute care facility, costing $57,000.00 and patients treated with
LMWH spent nine days, costing $9,000.00. We conclude that treatment with
LMWH was associated with a significant decrease in incidence of DVT/PE and an overall decline in health care costs of approximately $30,000 or approximately $1,250 per patient.