The coronavirus virus disease 2019 (COVID-19) is best known for its pulmonary sequelae. Understanding of the disease process is rapidly growing and the medical community already appreciates a hypercoagulable state associated with COVID-19. Acute spinal cord injury (SCI) has an inherent increased risk for venous thromboembolism (VTE). In this case report the patient presented with bilateral lower extremity weakness and sensory loss secondary to thoracic disc herniation. Incidentally, at the same time as the initial presentation, the patient was also found to have COVID-19 without significant respiratory symptoms. During hospitalization, the patient developed extensive bilateral lower extremity deep vein thrombosis (DVT) despite chemoprophylaxis. Therapeutic anticoagulation was initiated, yet several days later he developed pleuritic chest pain. Computed tomography (CT) angiography revealed bilateral pulmonary emboli. This case highlights the need for clinicians to have elevated vigilance in regards to screening and treatment for VTE in high-risk patients, such as SCI with a concurrent diagnosis of COVID-19.
Context/objective: To determine the prevalence of deep vein thrombosis (DVT) detected through routine duplex screening and factors associated with DVT in spinal cord injury (SCI) patients on admission to rehabilitation. Design: Retrospective chart review of medical records. Setting: Acute inpatient rehabilitation. Participants: One hundred and eighty-nine individuals admitted to rehabilitation within 2 weeks of initial traumatic SCI who underwent routine surveillance with duplex scan for DVT. Interventions: Duplex scan of lower extremities. Outcome measures: The dependent variable was positive duplex screening for either any DVT (distal and/or proximal) or proximal DVT. Results: Of the 189 patients, 31 patients (16.4%) had a positive scan for any (proximal and/or distal) DVT, with 9 (4.8%) positive for a proximal DVT and 22 (11.6%) positive for isolated distal DVT. Of those with isolated distal DVT, 31.8% later developed propagation with either proximal DVTs or pulmonary embolism (mean = 22 days). Factors significantly associated with positive duplex scans for any (proximal and/or distal) DVT include more severe neurological injury (AIS A, B or C versus AIS D: χ 2 = 7.1791, df = 1, P = 0.007) and older age (age ≥50 years old: χ 2 = 14.9410, df = 1, P = 0.000).
Conclusion:In acute traumatic SCI, older age and more severe neurological impairment (AIS A, B, and C) are independent risk factors for positive duplex screening for any (proximal and/or distal) DVT detected on rehabilitation admission. Individuals with an acute distal DVT have a high likelihood for future thrombus progression. Routine surveillance for these patients may be warranted.
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