Thromboembolic disease is a common occurrence in patients who have sustained a cervical spinal cord injury and is associated with significant morbidity. Class I medical evidence exists demonstrating the efficacy of several means of prophylaxis for the prevention of thromboembolic events. Therefore, patients with SCI should be treated with a regimen aimed at VTE prophylaxis. Although low dose heparin therapy has been reported to be effective as prophylaxis for thromboembolism in several Class III studies, other Class I, Class II, and Class III medical evidence indicates that better alternatives than low dose heparin therapy exist. These alternatives include the use of low molecular weight heparin, adjusted dose heparin, or anticoagulation in conjunction with rotating beds, pneumatic compression devices or electrical stimulation. Oral anticoagulation alone does not appear to be as effective as these other measures used for prophylaxis. There appears to be a DVT prophylaxis benefit to early anticoagulation in acute spinal cord injury patients. Class II medical evidence supports beginning mechanical and chemical prophylaxis upon admission after SCI and holding chemical prophylaxis 1 day prior to and 1 day following surgical intervention. © 2013 by the Congress of Neurological Surgeons.