Deep venous thrombosis in patients with chronic spinal cord injury

Mackiewicz−Milewska, Magdalena; Jung, Stanisław; Kroszczyński, Andrzej C.; Mackiewicz‐Nartowicz, Hanna; Serafin, Zbigniew; Cisowska-Adamiak, Małgorzata; Pyskir, Jerzy; Szymkuć-Bukowska, Iwona; Hagner, Wojciech; Rość, Danuta

doi:10.1179/2045772315y.0000000032

Cited by 38 publications

(40 citation statements)

References 26 publications

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“…DVT was diagnosed in McKinley et al [18] clinically or with 1–125 labelled fibrinogen uptake citation, impedance plethysmography, Doppler or venography. In Mackiewicz-Mile et al [22] DVT was diagnosed by D-dimer and ultrasound Doppler. Lamb et al [23] accepted any diagnostic method for VTE for inclusion; however we could not tell how patients were diagnosed with PE or DVT from the report.…”

Section: Resultsmentioning

confidence: 99%

“…We could not tell the sub-acute DVT incidence separately from the reported findings. In the third study, Mackiewicz-Milewska et al [22] presented an abstract of a prospective case series that included 63 spinal patients from the rehabilitation department in Bydgoszcz, Poland. The study reported five DVTs in the sub-acute phase diagnosed with Doppler ultrasound.…”

Section: Resultsmentioning

confidence: 99%

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Thromboembolism in the Sub-Acute Phase of Spinal Cord Injury: A Systematic Review of the Literature

et al. 2016

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To review the evidence of thromboembolism incidence and prophylaxis in the sub-acute phase of spinal cord injury (SCI) 3–6 months post injury. All observational and experimental studies with any length of follow-up and no limitations on language or publication status published up to March 2015 were included. Two review authors independently selected trials for inclusion and extracted data. Outcomes studied were incidence of pulmonary embolism (PE) and deep vein thrombosis (DVT) in the sub-acute phase of SCI. The secondary outcome was type of thromboprophylaxis. Our search identified 4305 references and seven articles that met the inclusion criteria. Five papers reported PE events and three papers reported DVT events in the sub-acute phase of SCI. Studies were heterogeneous in populations, design and outcome reporting, therefore a meta-analysis was not performed. The included studies report a PE incidence of 0.5%–6.0% and DVT incidence of 2.0%–8.0% in the sub-acute phase of SCI. Thromboprophylaxis was poorly reported. Spinal patients continue to have a significant risk of PE and DVT after the acute period of their injury. Clinicians are advised to have a low threshold for suspecting venous thromboembolism in the sub-acute phase of SCI and to continue prophylactic anticoagulation therapy for a longer period of time.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Thromboembolism in the Sub-Acute Phase of Spinal Cord Injury: A Systematic Review of the Literature

et al. 2016

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“…Although much has been debated about the incidence of DVT in acute SCI patients, the problem of DVT in subacute and chronic SCI is rarely discussed. 6 The guidelines as per the consortium for spinal cord medicine and ACCP suggest the use of chemical and mechanical prophylaxis for prevention of DVT in acute spinal cord injury patients. 7,8 But in cases of subacute and chronic spinal cord injury who are undergoing rehabilitation or admitted for various medical ailments, the chemical prophylaxis for DVT is difficult to supervise.…”

Section: Discussionmentioning

confidence: 99%

“…For a study with 95% confidence level, with prevalence of DVT considered as 7.9% 6 and 7% absolute error, the sample size calculated was 60.…”

Section: Methodsmentioning

confidence: 99%

A cross sectional study to measure prevalence of DVT in subacute and chronic spinal cord injury patients without any chemical prophylaxis

Pande¹,

Gogoi²,

Dubey³

et al. 2019

Int J Res Orthop

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Background: Prevalence of DVT in patients with sub-acute and chronic SCI has only been reported in a limited number of studies. Knowing the incidence of thromboembolic events in the sub-acute and chronic rehabilitation phase is important to estimate disease risk and facilitate evidence based prevention. We sought to determine the prevalence of DVT in patients of subacute and chronic phases post spinal cord injury without any chemical prophylaxis.Methods: Between June 2016 and April 2018, all cases of sub-acute and chronic spinal cord injury, undergoing rehabilitation at our centre were studied. Patients with pre-existing coagulopathy/hypercoagulable state/ bleeding diathesis or on medications for these conditions, tobacco smokers, chronic alcoholics and obese individuals were excluded from the study. All patients enrolled in the study were given mechanical DVT prophylaxis and followed institutional rehabilitation protocol. They were evaluated at 3 months, 6 months and 9 months by clinical examination and CDFI for any evidence of DVT.Results: Out of 60 patients studied, 04 patients developed DVT (3 in ASIA grade A and 1 in ASIA grade B patient). 75% (3 cases) of the cases were detected in the first 3 months and only one case was detected between 3-6 moths post Spinal cord injury. The prevalence of DVT in our study, in subacute and chronic cases of spinal cord injury was 6.67%.Conclusions: Our study is in concurrence with the existing literature about the low prevalence of DVT in Southeast Asian population which doesn’t warrant DVT chemoprophylaxis in subacute and chronic SCI cases.

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“…18,19 Three observational studies examined the role of D-dimer as a screening marker for VTE in patients with SCI. [20][21][22] Two studies reported no difference in D-dimer values in SCI patients who developed VTE compared with those without any events in acute 20 or chronic 21 phases after injury. Another study reported that D-dimer can be utilized as a surrogate marker to predict the likelihood of developing DVT in patients with cervical SCI, and concluded that the optimal timing of performing a D-dimer test should be 2 weeks after injury.…”

Section: Risk Factors For Venous Thromboembolismmentioning

confidence: 99%

Thromboprophylaxis in Patients with Acute Spinal Cord Injury: A Narrative Review

Piran

Schulman

2019

Semin Thromb Hemost

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Patients with acute spinal cord injury (SCI) have the highest risk of venous thromboembolism (VTE) among hospitalized patients. The incidence of total deep vein thrombosis ranges from 50 to 100% in untreated patients and pulmonary embolism is the third most common cause of mortality in these patients. The pathophysiology of the increased risk of VTE is explained by venous stasis after injury, endothelial vessel wall injury from surgery, and a hypercoagulable state associated with trauma. The current thromboprophylaxis options are limited, with low-molecular-weight heparin (LMWH) being the current standard of care. LMWH is commonly administered for 3 months, during which period the risk of VTE is especially high. Some uncertainty exists regarding the optimal timing to initiate pharmacological thromboprophylaxis and the best regimen of LMWH prophylaxis. High-quality data are currently lacking in thromboprophylaxis in patients with SCI. Many questions in this area remain to be answered, which are described in this narrative review.

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Deep venous thrombosis in patients with chronic spinal cord injury

Cited by 38 publications

References 26 publications

Thromboembolism in the Sub-Acute Phase of Spinal Cord Injury: A Systematic Review of the Literature

Thromboembolism in the Sub-Acute Phase of Spinal Cord Injury: A Systematic Review of the Literature

A cross sectional study to measure prevalence of DVT in subacute and chronic spinal cord injury patients without any chemical prophylaxis

Thromboprophylaxis in Patients with Acute Spinal Cord Injury: A Narrative Review

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