RECOMMENDATIONS Prophylaxis:

• Prophylactic treatment of venous thrombo-embolism (VTE) in patients with severe motor deficits due to spinal cord injury is recommended. • The use of low molecular weight heparins, rotating beds, or a combination of modalities is recommended as a prophylactic treatment strategy. • Low dose heparin in combination with pneumatic compression stockings or electrical stimulation is recommended as a prophylactic treatment strategy. Level II • Low dose heparin therapy alone is not recommended as a prophylactic treatment strategy. • Oral anticoagulation alone is not recommen-ded as a prophylactic treatment strategy. • Early administration of VTE prophylaxis (within 72 hours) is recommended. • A 3-month duration of prophylactic treat-ment for deep vein thrombosis (DVT) and pulmonary embolism (PE) is recommended. Level III • Vena cava filters are not recommended as a routine prophylactic measure, but are recom-mended for select patients who fail anti-coagulation or who are not candidates for anticoagulation and/or mechanical devices. Diagnosis: Level III • Duplex Doppler ultrasound, impedance pleth-ysmography, venous occlusion plethysmogra-phy, venography, and the clinical examination are recommended for use as diagnostic tests for DVT in the spinal cord injured population. RATIONALE DVT and PE collectively considered as VTE are problems frequently encountered in patients who have sustained cervical spinal cord injuries. Several means of prophylaxis and treatment are available, including anticoagulation, pneumatic compression devices, and vena cava filters. In 2002, the guide-lines author groupof the Joint Section onDisorders of the Spine and PeripheralNerves of the America