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

Piran, Siavash; Schulman, Sam

doi:10.1055/s-0039-1678720

Cited by 14 publications

(5 citation statements)

References 52 publications

(57 reference statements)

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“…They were divided equally into two groups of early (<48 h after surgery) versus late (≥48 h after surgery) initiation of thromboprophylaxis: DVT prevalence was significantly lower in the early group than in the late group (2.1% vs 10.8%, respectively, P < 0.01). 37,38 In our time effect study, there was an increasing trend of wet weight and dry weight of the thrombus from 2 h to 6 h after SCI, though there was no significant difference in the thrombus-inhibition effect between 1 h and 6 h. This result implied that thrombosis was closely related to the time of damage and anticoagulation therapy and that earlier treatment may help to reduce the thrombus size. Therefore, given the combined results of thromboprophylaxis and bleeding in the SC, EH could be administered <6 h in clinic after SCI to prevent thrombosis, which is earlier than LMWH.…”

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confidence: 62%

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Recombinant Neorudin for the Prevention of Deep-Vein Thrombosis After Spinal-Cord Injury

Liu,

Zhang

et al. 2023

DDDT

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Background Whether anticoagulant therapy should be used after spinal-cord injury (SCI) surgery was controversial. The anticoagulation characteristics of a newly developed anticoagulant, recombinant neorudin (EPR-hirudin (EH)), were explored using a rat model of SCI to provide a basis for clinical anticoagulation therapy of SCI. Methods A rat model of SCI was developed by Allen’s method. Then, thrombosis in the inferior vena cava was induced by ligation. The low-bleeding characteristics of EH were explored by investigating dose–response and time–effect relationships, as well as multiple administration of EH, on thrombus formation complicated with SCI. Results EH inhibited thrombosis in a dose-dependent manner by reducing the wet weight and dry weight of the thrombus. An inhibiting action of EH on thrombosis was most evident in the group given EH 2 h after SCI. After multiple intravenous doses of EH, thrombosis inhibition was improved to that observed with low molecular weight heparin (LMWH) (87% vs 90%). EH administration after SCI neither increased bleeding in the injured spine nor damaged to nerve function. Bleeding duration and activated partial thromboplastin time were increased in the high-dose EH group compared with that in the normal-saline group, but were lower than those in the LMWH group. Conclusion EH can reduce thrombus formation in a rat model of SCI, and bleeding is decreased significantly compared with that using LMWH. EH may prevent thrombosis after SCI or spinal surgery.

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confidence: 62%

Section: Discussionmentioning

confidence: 99%

Recombinant Neorudin for the Prevention of Deep-Vein Thrombosis After Spinal-Cord Injury

Liu,

Zhang

et al. 2023

DDDT

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“…Пострадавшие с осложненной травмой шейного отдела позвоночника зачастую подвергаются длительному нарушению кровообращения на фоне застоя крови в венах нижних конечностей, связанного как с нарушением иннервации сосудистой стенки, так и со снижением насосной функции мышц, обусловленной их параличом. Указанные факторы вместе с повреждением эндотелия и гиперкоагуляцией являются основными этиопатогенетическими составляющими, которые определяют принадлежность данной категории пациентов к группе наиболее высокого риска развития венозных тромбоэмболических осложнений [14][15][16].…”

Section: Discussionunclassified

Venous thromboembolism in complicated cervical spine injury

Lebedeva,

Vitkovskaya,

Ivanova

et al. 2024

Hir. pozvonoč.

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Objective. To determine incidence rate and risk factors for the development of venous thromboembolism in complicated cervical spine injury.Material and Methods. The study included 34 patients with acute complicated cervical spine injury. Inclusion criteria were newly diagnosed venous thromboembolic complications, and application of low-frequency piezothromboelastography to study the hemostasis system. All patients received standard drug thromboprophylaxis. Patients were divided into two study groups: Group I included 21 patientswith venous thromboembolic complications, and Group II – 13 patients without thromboembolic complications.Results. The incidence of venous thromboembolism in the total sample was 61.8 %. Pulmonary artery embolism developed in 4.7 % of cases. In 91,0 % of cases, thrombosis was asymptomatic. The state of the hemostatic system in Group I before the start of thromboprophylaxis was characterized by chronometric hypocoagulation, and structural hypercoagulation with a 2.6-fold increase in the intensity of clot retraction and lysis. In Group II, there was chronometric and structural hypercoagulation with a 14.4-fold increase in the intensity of clot retraction and lysis. The main significant predictors of the development of venous thromboembolism were identified as intestinal paresis (p = 0.004), absence of changes in neurological status (p = 0.012), length of stay in the ICU (p = 0.025), and length of hospitalstay (p = 0.039). The building of a multivariate logistic regression model revealed multiplicative significant predictors of the development of thromboembolism. It has been shown that the presence of intestinal paresis is associated with a 25.07-fold increase in the chances of developing DVT of lower extremities.Conclusion. Considering the high incidence of venous thromboembolic complications in patients with complicated cervical spine injury, further research is required to study the effectiveness and safety of correction of drug thromboprophylaxis regimens in the form of increasing doses of anticoagulants or the frequency of their administration.

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“…The existing laboratory examinations of clotting function are neither able to reflect coagulation nor to predict haemorrhage. Some specific diseases, such as severe liver dysfunction [ 8 ], will lead to significant abnormalities in coagulation test results, different from the actual state of hyper-coagulable [ 9 – 11 ]. Once a bleeding event occurs in patients treated with anti-thrombotic therapy, it is usually severe [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Application of artificial neural network in daily prediction of bleeding in ICU patients treated with anti-thrombotic therapy

Chen,

Wang,

Jiang

et al. 2023

BMC Med Inform Decis Mak

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Objectives Anti-thrombotic therapy is the basis of thrombosis prevention and treatment. Bleeding is the main adverse event of anti-thrombosis. Existing laboratory indicators cannot accurately reflect the real-time coagulation function. It is necessary to develop tools to dynamically evaluate the risk and benefits of anti-thrombosis to prescribe accurate anti-thrombotic therapy. Methods The prediction model,daily prediction of bleeding risk in ICU patients treated with anti-thrombotic therapy, was built using deep learning algorithm recurrent neural networks, and the model results and performance were compared with clinicians. Results There was no significant statistical discrepancy in the baseline. ROC curves of the four models in the validation and test set were drawn, respectively. One-layer GRU of the validation set had a larger AUC (0.9462; 95%CI, 0.9147–0.9778). Analysis was conducted in the test set, and the ROC curve showed the superiority of two layers LSTM over one-layer GRU, while the former AUC was 0.8391(95%CI, 0.7786–0.8997). One-layer GRU in the test set possessed a better specificity (sensitivity 0.5942; specificity 0.9300). The Fleiss’ k of junior clinicians, senior clinicians, and machine learning classifiers is 0.0984, 0.4562, and 0.8012, respectively. Conclusions Recurrent neural networks were first applied for daily prediction of bleeding risk in ICU patients treated with anti-thrombotic therapy. Deep learning classifiers are more reliable and consistent than human classifiers. The machine learning classifier suggested strong reliability. The deep learning algorithm significantly outperformed human classifiers in prediction time.

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

Cited by 14 publications

References 52 publications

Recombinant Neorudin for the Prevention of Deep-Vein Thrombosis After Spinal-Cord Injury

Recombinant Neorudin for the Prevention of Deep-Vein Thrombosis After Spinal-Cord Injury

Venous thromboembolism in complicated cervical spine injury

Application of artificial neural network in daily prediction of bleeding in ICU patients treated with anti-thrombotic therapy

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