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Research paper
Spinal haemorrhage during anticoagulant regimen for thromboprophylaxis: a unique form of central nervous system haemorrhage
  1. Julio C Furlan1,2,3,
  2. Gregory W Hawryluk1,4,5,
  3. James Austin1,4,
  4. Michael G Fehlings1,4,5,6
  1. 1Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
  2. 2Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Lyndhurst Centre, Toronto Rehabilitation Institute, University of Toronto, Toronto, Ontario, Canada
  4. 4Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
  5. 5Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  6. 6Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr Julio C Furlan, Toronto Western Research Institute, 399 Bathurst Street, McL 12-407, Toronto, Ontario, Canada; jcfurlan{at}


Introduction The management of anticoagulation (AC) therapy in patients with central nervous system (CNS) haemorrhage remains challenging. This study examines the potential factors associated with spinal haematoma among patients who develop CNS haemorrhage while on AC therapy.

Methods Based on a systematic review using MEDLINE and EMBASE, two reviewers screened publications and extracted data on all CNS-haemorrhage cases. First, all cases were grouped into brain, posterior fossa and spinal haemorrhage. Second, the spinal-haemorrhage group was subdivided into those patients experiencing complete neurological recovery, incomplete recovery, no recovery and death. Finally, axonal survival and inflammatory response after spinal cord injury (SCI) due to trauma and spinal haemorrhage were examined using postmortem spinal cord tissue.

Results Data were extracted from 72 publications including 553 patients. There were significant differences among the CNS groups regarding patient characteristics and management, while their outcomes were comparable. Outcomes among the spinal-haemorrhage subgroups were not associated with patient characteristics and management. Postmortem examination of spinal cord showed that axonal survival and inflammatory response in a spinal-haemorrhage case were similar to a case of traumatic SCI.

Conclusions The results of this study suggest that the management of patients with spinal haemorrhage considerably differ from individuals with an intracranial haemorrhage during AC. However, survival and neurological recovery appear to be comparable among the CNS groups. The studied factors failed to discriminate the patient subgroups according to survival and neurological recovery. Finally, the neuropathology result reinforces the possibility that the mechanism of SCI may not be relevant for axonal survival and inflammatory response within the spinal cord.

  • Spine
  • anticoagulant
  • haemorrhage
  • systematic review
  • spinal cord injury
  • epidemiology
  • clinical neurology
  • neuroepidemiology
  • neuropathology
  • statistics
  • clinical neurology
  • haematology
  • neurosurgery
  • pharmacology
  • stroke
  • neurosurgery

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  • Funding This research project was funded by Christopher & Dana Reeve Foundation (JCF, MGF) and AO Spine North America (GH, MGF).

  • Competing interests None.

  • Ethics approval Ethics approval was granted by the University Health Network Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.