Duplex ultrasound surveillance for deep vein thrombosis after acute traumatic spinal cord injury at rehabilitation admission

Hon, Beverly; Botticello, Amanda L.; Kirshblum, Steven

doi:10.1080/10790268.2019.1585134

Cited by 16 publications

(14 citation statements)

References 35 publications

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“…The frequency of a positive DVT in acute rehabilitation hospitals with routine duplex screening has varied, and generally, rates are between 6.5% and 18% for higher-risk groups including in persons with traumatic spinal cord and brain injury, as well as amputations. 27,28 Patients with severe COVID-19 who survive the hospitalization often have neurologic or other functional deficits that require acute in-patient rehabilitation. 29 However, to date, there has been no information regarding the incidence of DVT in patients admitted to a rehabilitation hospital published.…”

Section: What Is Newmentioning

confidence: 99%

Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital

Kirshblum

Delauter

Eren

et al. 2021

Am J Phys Med Rehabil

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Objective The aim of the study was to determine the prevalence of deep venous thrombosis detected by duplex screening and risk factors associated with deep venous thrombosis in patients with COVID-19 upon admission to an inpatient rehabilitation hospital. Design This is a retrospective review. Setting The setting is three freestanding inpatient rehabilitation hospitals operating as one system. Participants The participants are consecutive patients with a diagnosis of COVID-19 admitted to an inpatient rehabilitation hospital without a diagnosis of deep venous thrombosis or screening duplex ultrasound prior to transfer. Interventions A duplex ultrasound of lower limbs was performed upon admission to inpatient rehabilitation hospital. Outcome Measures Primary outcome was the percentage of admission patients with a lower limb deep venous thrombosis. Secondary factors included potential risk factors for a positive screen for deep venous thrombosis. Results A lower limb deep venous thrombosis was diagnosed in 22% (25/113) of the patients tested, with eight patients (7.1%) having a proximal deep venous thrombosis. Risk factors for screening positive for a deep venous thrombosis included being male, younger, and having been on a ventilator during the acute illness. Conclusions The high rate of deep venous thrombosis observed in these patients suggests that the risk of venous thromboembolic disorders after severe COVID-19 illness is considerable and surveillance measures of such patients should be undertaken.

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Section: What Is Newmentioning

confidence: 99%

Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital

Kirshblum

Delauter

Eren

et al. 2021

Am J Phys Med Rehabil

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“…Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and venous pulmonary embolism (PE), is a common and preventable complication in patients undergoing rehabilitation, which can result in significant morbidity and death [ 1 – 7 ]. Prolonged bed rest (>14 days) is associated with a five-fold increased risk of developing DVT [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Enoxaparin for VTE thromboprophylaxis during inpatient rehabilitation care: assessment of the standard fixed dosing regimen

Haim,

Avnery,

Rubin-Asher

et al. 2024

BMC Pharmacol Toxicol

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Background We aimed to examine the efficiency of fixed daily dose enoxaparin (40 mg) thromboprophylaxis strategy for patients undergoing inpatient rehabilitation. Methods This was an observational, prospective, cohort study that included 63 hospitalized patients undergoing rehabilitative treatment following sub-acute ischemic stroke (SAIS) or spinal cord injury (SCI), with an indication for thromboprophylaxis. Anti-Xa level measured three hours post-drug administration (following three consecutive days of enoxaparin treatment or more) was utilised to assess in vivo enoxaparin activity. An anti-Xa level between 0.2-0.5 U/ml was considered evidence of effective antithrombotic activity. Results We found sub-prophylactic levels of anti-Xa (<0.2 U/ml) in 19% (12/63). Results were within the recommended prophylactic range (0.2-0.5 U/ml) in 73% (46/63) and were supra-prophylactic (>0.5 U/ml) in 7.9% (5/63) of patients. Anti-Xa levels were found to inversely correlate with patients’ weight and renal function as defined by creatinine clearance (CrCl) (p<0.05). Conclusions Our study confirmed that a one-size-fits-all approach for venous thromboembolism (VTE) prophylaxis may be inadequate for rehabilitation patient populations. The efficacy of fixed-dose enoxaparin prophylaxis is limited and may be influenced by renal function and weight. This study suggests that anti-Xa studies and prophylactic enoxaparin dose adjustments should be considered in certain patients, such as those who are underweight, overweight and or have suboptimal renal function. Trial registration No. NCT103593291, registered August 2018.

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“…Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and venous pulmonary embolism (PE), is a common and preventable complication in patients undergoing rehabilitation, which can result in signi cant morbidity and death [1][2][3][4][5][6][7]. Prolonged bed rest (> 14 days) is associated with a ve-fold increased risk of developing DVT [4].…”

Section: Introductionmentioning

confidence: 99%

Enoxaparin for VTE thromboprophylaxis for inpatient rehabilitation care: assessment of the standard fixed dosing regimen

Haim

Avnery

Asher

et al. 2023

Preprint

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Background. We aimed to examine the efficiency of fixed daily dose enoxaparin (40 mg) thromboprophylaxis strategy for patients undergoing inpatient rehabilitation. Methods. This was an observational, prospective, cohort study that included 63 hospitalized patients undergoing rehabilitative treatment following sub-acute ischemic stroke (SAIS) or spinal cord injury (SCI), with an indication for thromboprophylaxis. Anti-Xa level measured three hours post-drug administration (following three consecutive days of enoxaparin treatment or more) was utilised to assess in vivo enoxaparin activity. An anti-Xa level between 0.2–0.5 U/ml was considered evidence of effective antithrombotic activity. Results. We found sub-prophylactic levels of anti-Xa (< 0.2 U/ml) in 19% (12/63). Results were within the recommended prophylactic range (0.2–0.5 U/ml) in 73% (46/63) and were supra-prophylactic (> 0.5 U/ml) in 7.9% (5/63) of patients. Anti-Xa levels were found to inversely correlate with patients’ weight and renal function as defined by creatinine clearance (CrCl) (p < 0.05). Conclusions. Our study confirmed that a one-size-fits-all approach for venous thromboembolism (VTE) prophylaxis may be inadequate for rehabilitation patient populations. The efficacy of fixed-dose enoxaparin prophylaxis is limited and may be influenced by renal function and weight. This study suggests that anti-Xa studies and prophylactic enoxaparin dose adjustments should be considered in certain patients, such as those who are underweight, overweight and or have suboptimal renal function. Trial Registration. No. NCT103593291, registered August 2018.

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Duplex ultrasound surveillance for deep vein thrombosis after acute traumatic spinal cord injury at rehabilitation admission

Cited by 16 publications

References 35 publications

Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital

Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital

Enoxaparin for VTE thromboprophylaxis during inpatient rehabilitation care: assessment of the standard fixed dosing regimen

Enoxaparin for VTE thromboprophylaxis for inpatient rehabilitation care: assessment of the standard fixed dosing regimen

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