Impact of coagulation in the development of thromboembolic events in patients with spinal cord injury

Abstract

Study design: Although the knowledge described about risk factors and venous thromboembolism (VT) in the general population, the impact of these factors in the development of thromboembolic events in patients with spinal injury (SI) caused by spinal cord injury (SCI) is poorly understood. Objective: Evaluate the impact of risk factors in the development of thromboembolic events in patients with SCI. Setting: Brazil, São Paulo. Methods: Observational, prospective and cross-study. Eligible patients (n ¼ 100) had SI by SCI, 418 years. The degree of motor and sensory lesion was evaluated based on American Spinal Injury Association (ASIA) Impairment Scale (AIS). Blood samples were collected for coagulation exams, hemogram, laboratory and biochemical analyses. Ultrasonography analyzes were performed from deep and superficial venous systems of lower limbs. Quantitative real-time PCR experiments were performed in order to investigate mutations in the prothrombin (G20210A) and Leiden factor V (G1691A) genes. Results: The main finding of this study was the higher occurrence of deep venous thrombosis (DVT) in patients with Leiden factor V and hyperhomocysteinemia. There was no association between SI for DVT, VT and thrombophilia. Also, there was no relation between lupus anticoagulant and anti-cardiolipin. Conclusion: There is an important difference in the incidence of DVT in patients with SI by acute and chronic SCI. Therefore, the conduct of the investigation for thrombophilia should be based on clinical factors, risk factors for DVT and family history of thrombosis. Spinal Cord (2014) 52, 327-332; doi:10.1038/sc.2013.170; published online 11 February 2014Keywords: thromboembolism; spinal cord injury; Leiden factor V; hyperhomocysteinemia.The venous thromboembolism (VT), that involves deep venous thrombosis (DVT) and pulmonary embolism, is considered a common disease, with annual incidence of one to three cases per 1000 individuals. 1 There are many factors related to VT, including age, male gender, pelvic and lower limb fractures and spinal injury (SI). 2 It is well established in the literature the relation between DVT and SI. This incidence has increased in the last years, 3 ranging between 18 and 100%, depending on the diagnostic methods used, lesion time, associated risk factors and prophylactic treatment. 4 Sequelae from SI can affect the three components from classic Virchow triad, responsible for the genesis of VT: blood flow changes, endothelial cell damage and production of procoagulants, leading to hypercoagulability state. Besides, pulmonary embolism is the serious complication and is the second leading death cause in these patients. The incidence of pulmonary embolism varies between 4.6 and 14% of the cases, being fatal between 1.7 and 4.7%. 5 In the venous system vascular, many changes can induce DVT, for example, partial or total paralysis of the muscles, affecting the blood flow due changes in the venous competence, causing the reduction in the capacity and distensibility of vascular bed and increase in ...

Circulating neutrophil-to-lymphocyte ratio at admission predicts the long-term outcome in acute traumatic cervical spinal cord injury patients

“…The prognostic value of predictors is determined by their reliability on assessment, the prevalence of abnormalities, and the strength of the prognostic effect [ 17 ]. Predictors we used in this study, including age, gender, coagulation status and components of circulating blood sample, can be readily obtained on admission, and their prognostic value had previously been confirmed either in tSCI or TBI patients [ 6 , 17 – 19 ]. The counts of WBCs and its components, including neutrophils ratio, lymphocytes ratio and NLR, are readily available lab tests with standardized results, although rarely studied, it is reasonable to include these results into this prognostic model.…”

Frequency of venous thromboembolism events during acute inpatient rehabilitation in a comprehensive cancer centre

“…There has been a considerable amount of research in a variety of inpatient rehabilitation populations, including general rehabilitation (11)(12)(13), post-orthopaedic surgery (14,15), spinal cord injury (16)(17)(18), general neurology (19,20), traumatic brain injury (21,22), stroke (23), and cardiac (24)(25)(26) rehabilitation inpatients. To our knowledge, there are no studies of VTE in cancer rehabilitation inpatients.…”

Circulating Neutrophil-to-Lymphocyte Ratio at Admission Predicts the Long-Term Outcome in Acute Traumatic Cervical Spinal Cord Injury Patients

“…Predictors we used in this study, including age, gender, coagulation status and components of circulating blood sample, can be readily obtained on admission, and their prognostic value had previously been con rmed either in tSCI or TBI patients. [4,[15][16][17] The counts of WBCs and its components, including neutrophils ratio, lymphocytes ratio and NLR, are readily available lab tests with standardized results, although rarely studied, it is reasonable to include these results into this prognostic model. Favorable prognostic value of circulating NLR at admission had been reported in ICH and TBI patients.…”