Venous Thromboembolism in Cancer-related Spinal Cord Injury: A Phased-specific Clinical Approach

Abstract Purpose of Review Venous thromboembolism (VTE) in cancer-related spinal cord injury (crSCI) likely reflects the convergence of malignant hypercoagulability, profound immobility, and frequent spine procedures, a combination that is biologically plausible but not yet defined as a distinct epidemiologic entity. Existing guidelines largely treat cancer and spinal cord injury (SCI) separately. This review aims to synthesize current evidence pertinent to crSCI across epidemiology, diagnosis, prophylaxis, and treatment, and to translate it into a practical clinical approach for prevention and management of VTE in this uniquely high-risk population. Recent Findings Recent systematic reviews confirm sustained, high VTE rates in both cancer and SCI, with emerging data highlighting substantial thrombotic risk after metastatic spine surgery and during inpatient rehabilitation. Contemporary oncology guidelines endorse low molecular weight heparin and direct oral anticoagulants as first-line therapy for prophylaxis and treatment of cancer-associated VTE but exclude most patients with spinal tumors, recent decompression, or epidural disease, leaving major evidence gaps for crSCI. Summary CrSCI is best viewed as a high-risk clinical construct rather than a formally established epidemiologic category, in which standard cancer or SCI algorithms are insufficient, underscoring the need for phase-specific, individualized risk mitigation strategies that prioritizes early mechanical prophylaxis, timely but cautious initiation of chemoprophylaxis, and highly individualized decisions around screening, inferior vena cava filters, and peri-procedural management. Clarifying optimal screening practices, anticoagulant selection, and treatment duration in prospective crSCI cohorts is crucial to reduce VTE-related morbidity while minimizing catastrophic spinal bleeding.