***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a prospect i ve , r and omized , open study , the therapeutic efficacy of a long-term prophylaxis with st and ard heparin ( SH ) was compared with that of low-molecular-weight heparin ( LMWH ) Dalteparin in 166 patients who had spinal fractures with spinal cord injury . 86 patients were treated with SH 2 x 7500 U s.c . and 80 patients were treated with LMWH 1 x 5000 anti-Xa U s.c . once daily . The screening was implemented by daily bedside-examination . In case of clinical thromboembolism-symptoms patients had confirmatory venography or lung scans . In the SH-group 12 ( 14.0 % ) patients had deep vein thrombosis and in the LMWH-group 6 ( 7.5 % ) . Pulmonary embolism was detected two times in the SH-group ( 2.33 % ) and only one time in the LMWH-group ( 1.25 % ) . A significant difference could not be shown , but is descriptive evident Acute spinal cord injury patients were assigned alternately to a control and a heparin prophylaxis group to determine the effect of 5,000 μ sodium heparin subcutane-ously every 12 hours on the incidence of venous thrombosis as detected by impedance plethysmography of the lower extremities . Venous thrombosis was unexpectedly uncommon in both the control ( 1 of 17 ) and the heparinised ( 1 of 15 ) group , suggesting an unidentified , overriding prophylactic factor BACKGROUND This prospect i ve , multicenter study compared low-dose unfractionated heparin ( UFH ) with enoxaparin for prophylaxis against venous thromboembolism ( VTE ) during the rehabilitation phase after spinal cord injury . METHODS After 2 weeks of acute-phase prophylaxis , patients without objective evidence of VTE entered the rehabilitation phase and received up to 6 additional weeks of thromboprophylaxis with either UFH 5,000 U every 8 hours or enoxaparin 40 mg once daily . Patients then underwent repeat bilateral lower extremity duplex ultrasonography . RESULTS Among 119 patients who completed the rehabilitation phase and had adequate imaging , new VTE was demonstrated in 13 of 60 UFH versus 5 of 59 enoxaparin patients ( 21.7 % vs. 8.5 % ; p = 0.052 ) . Only one patient from each group was discontinued from the study because of bleeding . CONCLUSION In this nonr and omized comparison , enoxaparin appeared more effective than heparin in the prevention of thromboembolic complications during rehabilitation after spinal cord injury . Both interventions were safe in this population BACKGROUND The risk of venous thromboembolism is high after spinal cord injury ( SCI ) . This prospect i ve , multicenter study compared unfractionated heparin ( UFH ) plus intermittent pneumatic compression ( IPC ) to enoxaparin alone as thromboprophylaxis after SCI . METHODS Patients with acute SCI were r and omly assigned to receive either UFH , 5,000 U every 8 hours , in combination with IPC or enoxaparin , 30 mg every 12 hours . Outcome measures were deep vein thrombosis , pulmonary embolism , and major bleeding after 2 weeks of prophylaxis . RESULTS Among 107 assessable patients , the incidence of venous thromboembolism was 63.3 % with UFH-IPC versus 65.5 % with enoxaparin ( p = 0.81 ) . The incidence of PE was 18.4 % with UFH-IPC versus 5.2 % with enoxaparin ( p = 0.03 ) . Among all r and omized patients , the incidence of major bleeding was 5.3 % with UFH-IPC versus 2.6 % with enoxaparin ( p = 0.14 ) . CONCLUSION In the acute treatment phase after SCI , safety and thromboprophylactic efficacy were generally similar with UFH-IPC and enoxaparin Study design : R and omized study . Objectives : To find out the incidence of deep vein thrombosis ( DVT ) in acute spinal cord injury ( SCI ) patients with and without therapeutic prophylaxis .  Setting : Patients admitted in the department of Physical Medicine & Rehabilitation , SMS Medical College , Jaipur , India . Methods : All 297 patients received physical therapy measures  and were r and omly divided into two groups . 166 patients received prophylactic heparin , whereas 131 patients did not . Results : A total of three cases ( 1.8 % ) in study group and four cases ( 3 % ) in control group developed DVT . This difference was statistically insignificant ( P>0.05 ) . Conclusion : Incidence of DVT in SCI is low in our study Chiou-Tan FY , Garza H , Chan KT , Parsons KC , Donovan WH , Robertson CS , Holmes SA , Graves DE , Rintala DH : Comparison of dalteparin and enoxaparin for deep venous thrombosis prophylaxis in patients with spinal cord injury . Am J Phys Med Rehabil 2003;82:678–685 . Objective To determine differences between dalteparin and enoxaparin in patients with spinal cord injury . Design This prospect i ve , r and omized , open-label study was performed as a multiple hospital trial in a large urban setting . A total of 100 patients with acute ( <3 mo ) spinal cord injury were recruited . A total of 95 patients met all inclusion criteria . Fifty received enoxaparin , and 45 received dalteparin . Main outcome measures included deep venous thrombosis , bleeding , compliance , Short Form-12 Health Status Survey , satisfaction , and medication/labor costs . Patients were r and omized to receive 30 mg of enoxaparin subcutaneously every 12 hr or 5000 IU of dalteparin subcutaneously once daily . Prophylaxis was continued for 3 mo for motor-complete and 2 mo for motor-incomplete patients . Results Six percent of the patients developed deep venous thrombosis while receiving enoxaparin and 4 % while receiving dalteparin ( & khgr;2 = 0.44 , df = 1 , P = 0.51 ) . Four percent developed bleeding while receiving dalteparin and 2 % while receiving enoxaparin ( & khgr;2 = 0.13 , df = 1 , P = 0.72 ) . No differences were noted in compliance , health status , or most of the satisfaction measures . It was , however , noted that after being discharged home , the patients receiving enoxaparin rated the shots significantly more inconvenient ( two injections per day ) compared with taking three pills per day , than those receiving dalteparin ( one injection per day , P < 0.05 ) . The cost of the medication was $ 1101/mo for enoxaparin ( two injections per day ) and $ 750/mo for dalteparin ( one injection per day ) . Conclusion Similar compliance , health status , deep venous thrombosis , and bleeding rates were found between dalteparin and enoxaparin BACKGROUND To compare the impact of switching from enoxaparin 30 mg subcutaneously ( SC ) twice daily to dalteparin 5,000 units SC once daily for venous thromboembolism ( VTE ) prophylaxis in critically-ill major orthopedic trauma and /or acute spinal cord injury ( SCI ) patients . METHODS DETECT was a retrospective , cohort study at a tertiary care referral teaching center-phase 1 from December 1 , 2002 to November 30 , 2003 ( enoxaparin ) ; and phase 2 from January 1 , 2004 to December 31 , 2004 ( dalteparin ) . Major orthopedic trauma patients with pelvic , femoral shaft , or complex lower extremity fractures , and /or acute SCI patients admitted to the intensive care unit and who received a low-molecular-weight heparin ( LMWH ) for VTE prophylaxis were included . RESULTS DETECT review ed 135 patients ( 63 enoxaparin , 72 dalteparin ) , with similar baseline demographics , clinical characteristics , injuries , severity of illness , and risk factors for VTE . Clinical ly symptomatic proximal deep vein thrombosis ( DVT ) or pulmonary embolism ( PE ) rates were 1.6 % with enoxaparin and 9.7 % with dalteparin ( p=0.103 , absolute risk increase [ ARI ] of 8.1 % [ -0.6 % to 15.6 % ] ) , with no differences in major bleeding ( 6.4 % versus 6.9 % ) or minor bleeding ( 64 % versus 69 % ) , or mortality ( 4.8 % versus 6.9 % ) . Switching from enoxaparin to dalteparin was associated with $ 12,485 ( CAD ) in LMWH acquisition cost savings . CONCLUSIONS DETECT raises the hypothesis that dalteparin 5,000 units SC daily may not be clinical ly noninferior to enoxaparin 30 mg SC twice daily for VTE prophylaxis in this high-risk population . Until an adequately-powered , prospect i ve noninferiority trial is performed , enoxaparin is supported by level 1 evidence and should be the prophylactic agent of choice The purpose of this prospect i ve , r and omized study was to evaluate the efficacy of low-dose heparin , alone or in combination with electric stimulation , in the prevention of  deep vein thrombosis ( DVT ) in C2 to T11 motor complete and incomplete-preserved motor , nonfunctional spinal cord injured patients . The tibialis anterior and gastrocnemius-soleus muscle groups were stimulated bilaterally , using 50 microsecond pulses given at 10Hz with a four-second " on " and an eight-second " off " cycle for 23 hours daily over a 28-day period . Forty-eight patients , less than two weeks after injury , were r and omly assigned to saline placebo ( n = 17 ) , low-dose heparin ( 5,000U , subcutaneous every eight hours ) ( n = 16 ) , and low-dose heparin plus electric stimulation ( n = 15 ) . A normal 125-I fibrinogen scan and impedance plethysmography were required for entry into the study . Surveillance for DVT was evaluated by daily 125-I fibrinogen scanning . Venography was performed to confirm a positive impedance plethysmography and /or 125-I fibrinogen scanning tests for two consecutive days and at the completion of the study . The incidence of DVT was 8 of 17 in the placebo group , 8 of 16 in the low-dose heparin group , and 1 of 15 in the electric stimulation plus low-dose heparin group . The use of electric stimulation plus low-dose heparin significantly ( p less than 0.05 ) decreased the incidence of DVT compared to the other treatments Thromboembolism is a common and occasionally catastrophic complication in patients with spinal cord injury and complete motor paralysis . We , therefore , evaluated the efficacy and safety of two prophylactic regimens , using heparin in either fixed doses of 5000 U given subcutaneously twice daily or in doses adjusted to prolong the activated partial thromboplastin time ( APTT ) to approximately 1 1/2 times control . Patients were monitored with daily clinical examinations , serial impedance plethysmography , and Doppler flow studies . All events suspected to be thromboembolic were confirmed by venography , ventilation-perfusion scans , or pulmonary angiography . Seventy-five patients were r and omized , and 58 ( 29 in each group ) either remained in the study for more than seven weeks or experienced a thrombotic or hemorrhagic event . Patients on the adjusted-dose regimen received a mean ( + /- SD ) of 13,200 + /- 2200 U of  heparin  per dose and had an APTT 1 1/2 times higher than those on the fixed-dose regimen . Thromboembolism was detected in nine ( 31 % ) of 29 patients r and omized to the fixed-dose regimen and two ( 7 % ) of 29 on the adjusted-dose regimen . While no patient who received the adjusted dose and whose APTT reached the target level had a thrombosis , bleeding occurred in seven patients . No patient on the fixed-dose regimen bled . We conclude that patients with spinal cord injury who can be maintained on doses of heparin sufficient to prolong their APTT to 1 1/2 times control values will be spared thromboembolic complications , but these patients are at high risk of bleeding , especially if they have trauma to other tissues in addition to their spinal cord injury 
    Output:
    
Conclusion : Our meta- analysis showed that in patients with acute SCI , LDUH have no thromboprophylaxis effect compared with placebo or untreated ; LMWH seems only can reduce bleeding incidence , but not prophylaxis thromboembolism compared with LDUH .