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Thromb Haemost 2013; 109(01): 34-38
DOI: 10.1160/TH12-06-0390
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

The short- and long-term risk of venous thromboembolism in patients with acute spinal cord injury

A prospective cohort study
Matteo Giorgi Pierfranceschi
1   Emergency Department, Piacenza Hospital, Piacenza , Italy
,
Marco P. Donadini
2   Department of Clinical Medicine, University of Insubria, Varese, Italy
,
Francesco Dentali
2   Department of Clinical Medicine, University of Insubria, Varese, Italy
,
Walter Ageno
2   Department of Clinical Medicine, University of Insubria, Varese, Italy
,
Marina Marazzi
3   Spinal Rehabilitation Unit, Piacenza Hospital, Piacenza, Italy
,
Romeo Bocchi
3   Spinal Rehabilitation Unit, Piacenza Hospital, Piacenza, Italy
,
Davide Imberti
4   Internal Medicine Department, Piacenza Hospital, Piacenza, Italy
› Author Affiliations
Further Information

Publication History

Received: 12 June 2012

Accepted after major revision: 28 September 2012

Publication Date:
25 November 2017 (online)

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Summary

Venous thromboembolism (VTE) is a frequent complication in the acute setting after spinal cord injury (SCI). Less is known about the long-term risk of VTE in these patients. It was the aim of this study to prospectively evaluate the short- and long-term risk of VTE in a cohort of patients after acute SCI and during rehabilitation and post-rehabilitation follow-up period. From January 2003 to November 2007 all consecutive adult patients admitted to a Spinal Rehabilitation Unit (RU) after surgical treatment in three Neurosurgical Units for SCI, were enrolled. After an accurate evaluation of their neurosurgical medical records the patients were prospectively evaluated for VTE occurrence. Ninety-four patients (80 males; mean age 40.3 years, SD 15.9) were recruited. All the patients received thromboprophylaxis with low-molecular-weight heparin combined with compressive stockings during hospitalization (median duration 7 months, IQR 4.5–8.8). Over a median follow-up period of 36.3 months (IQR 4.4–48) after SCI, VTE was diagnosed in 22 patients (23.4%) The majority of VTE events were recorded during the first three months of follow-up (34.4 VTE events/100 patient-years in the first 3 months and 0.3 VTE events/100 patient-years thereafter); age over 45 years (HR 8.4, 95% CI 3–23.5), previous VTE (HR 6.0, 95% CI 1.6–23.3) and paraplegia (HR 4.7, 95% CI 1.6–13.7) were independently associated with the occurrence of VTE. In conclusion, the risk of VTE in patients suffering from SCI is high despite the use of thromboprophylaxis, in particular in some patients categories. However, this risk appears to be limited to the first 3 months after the index event.

Keywords

Long-term risk of VTE - deep-vein thrombosis - spinal cord injury
 

  • References

  • 1 De Vico MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil 1999; 80: 1411-1419. DOI:10.1016/S0003-9993(99)90252-6.
    CrossrefPubMedGoogle Scholar
  • 2 Sipski ML, Richards JS. Spinal cord injury rehabilitation: State of the science. Am J Phys Med Rehabil 2006; 85: 310-342. DOI:10.1097/01.phm.0000202105.87011.bf.
    CrossrefPubMedGoogle Scholar
  • 3 Chen D, Apple DF, Hudson LM. et al. Medical complications during acute rehabilitation following spinal cord injury : current experience of the Model Systems. Arch Phys Med Rehabil 1999; 80: 1397-1401. DOI:10.1016/S0003-9993(99)90250-2.
    CrossrefPubMedGoogle Scholar
  • 4 Brach BB, Moser KM. et al. Venous thrombosis in acute spinal cord paralysis. J. Trauma 1977; 17: 289-292. DOI:10.1097/00005373-197704000-00005.
    CrossrefPubMedGoogle Scholar
  • 5 Geerts WH, Code KI. et al. A prospective study of venous thromboembolism after major trauma. N Eng J Med 1994; 331: 1601-1606. DOI:10.1056/NEJM199412153312401.
    CrossrefPubMedGoogle Scholar
  • 6 Waring WP, Karunas RS. Acute spinal cord injuries and the incidence of clinically occurring thromboembolic disease. Paraplegia 1991; 29: 8-16. DOI:10.1038/sc.1991.2.
    PubMedGoogle Scholar
  • 7 Green D, Chen D, Soltysik RC. et al. Spinal Cord Injury Assessment for Thromboembolism (SPIRATE Study). Am J Phys Med Rehabil 2003; 82: 950-956. DOI:10.1097/01.PHM.0000098043.88979.BA.
    CrossrefPubMedGoogle Scholar
  • 8 Green D, Twardowski P, Wei R. et al. Fatal pulmonary embolism in spinal cord injury. Chest 1994; 105: 853-855. DOI:10.1378/chest.105.3.853.
    CrossrefPubMedGoogle Scholar
  • 9 Paciaroni M, Ageno W, Agnelli G. Prevention of venous thromboembolism after acute spinal cord injury with low-dose heparin or low molecular weight heparin. Thromb Haemost 2008; 99: 978-980.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Chiou-Tan FY, Garza H, Chan KT. et al. comparison of dalteparin and enoxaparin for deep venous thrombosis prophylaxis in patient with spinal cord injury. Am J Phys Med Rehabil 2003; 82: 678-685. DOI:10.1097/01.PHM.0000083671.27501.47.
    CrossrefPubMedGoogle Scholar
  • 11 Danish SF, Burnett MG, Stein SC. Prophylaxis for deep venous thrombosis in patients with craniotomies: review. Neurosur Focus 2004; 17: E2.
    PubMedGoogle Scholar
  • 12 Spinal cord injury thromboprophylaxis Investigators.. Prevention of venous thromboembolism in the acute treatment phase after spinal cord injury: a randomized, multicenter trial comparing low-dose heparin plus intermittent pneumatic compression with enoxaparin. J Trauma 2003; 54: 1116-1126. DOI:10.1097/01.TA.0000066385.10596.71.
    CrossrefPubMedGoogle Scholar
  • 13 Gould MK, Garcia DA, Wren SM. et al. Prevention of VTE in Nonorthopedic Surgical Patients: Antithrombotic therapy and prevention of thrombosis, 9 th ed: American College of Chest Physicians evidence-based clinical practice guideline. Chest 2012; 141: e227S-e277S. DOI:10.1378/chest.11-2297.
    CrossrefPubMedGoogle Scholar
  • 14 Schulman S, Kearon C. Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis (ISTH).. Definition of major bleeding in clinical investigations of antihemostatic medical products in non-surgical patients. J Thromb Haemost 2005; 03: 692-694. DOI:10.1111/j.1538-7836.2005.01204.x.
    CrossrefPubMedGoogle Scholar
  • 15 Ageno W, Agnelli G, Checchia G. et al., Italian Society for Haemostasis and Thrombosis.. Prevention of venous thromboembolism in immobilized neurological patients: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res 2009; 124: 26-31. DOI:10.1016/j.thromres.2009.06.032.
    CrossrefPubMedGoogle Scholar
  • 16 Kadyan V, Clinchot DM, Colachis SC. Cost-effectiveness of duplex ultrasound surveillance in spinal cord injury. Am J Phys Med Rehabil 2004; 83: 191-197. DOI:10.1097/01.PHM.0000113401.47681.A6.
    CrossrefPubMedGoogle Scholar
  • 17 Greer IA, Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a sistematyc review of safety and efficacy. Blood 2005; 106: 401-407. DOI:10.1182/blood-2005-02-0626.
    CrossrefPubMedGoogle Scholar
  • 18 Schellong SM, Beyer J, Kakkar AK. et al. Ultrasound screening for asymptomatic deep vein thrombosis after major orthopedic surgery: the VENUS study. J Thromb Haemost 2007; 05: 1431-1437. DOI:10.1111/j.1538-7836.2007.02570.x.
    CrossrefPubMedGoogle Scholar