Incidence of Deep Vein Thrombosis after Spinal Cord Injury in Korean Patients at Acute Rehabilitation Unit

Abstract

Deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) remain significant causes of morbidity, mortality in patients with spinal cord injury (SCI). Since incidence of DVT after SCI in Korean population has not been much studied, we retrospectively analyzed the medical records of 185 SCI patients admitted for acute rehabilitation unit to investigate the incidence of DVT. Color Doppler ultrasonography was performed to screen for the occurrence of DVT at the time of initial presentation to acute rehabilitation unit. Primary study outcome was the incidence of DVT. Possible risk factors for DVT including the epidemiologic characteristics, completeness of motor paralysis, cause of injury, spasticity, surgery, and active cancer were analyzed. The incidence of DVT after SCI was 27.6%. In multiple logistic regression analysis, absence of spasticity was a significant independent risk factor (P<0.05) for occurrence of DVT. Symptomatic pulmonary embolism was evident in 7 patients without an episode of sudden death. Therefore, it is concluded that the incidence of DVT after SCI in Korean patients is comparable with that in Western populations. This result suggests that pharmacologic thromboprophylaxis should be considered in Korean patients with SCI.

Deep venous thrombosis in patients with chronic spinal cord injury

“…21,22 According to various authors, the percentage of detected distal DVT ranges from 5 to 76.5%. 23,24 DVT pharmacological prophylaxis with LMWH decreases its rate of what has been reported through multiple studies. 5,14,25,26 Most of the authors recommend the aforementioned level of prophylaxis until the end of the 2nd 1,25 or 3rd month post-injury.…”

Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.

“…There are a number of potential reasons for this, including the recovery of muscle stretch reflexes and tone following the acute period of spinal shock (DeVivo, 1999;Do, 2013). Data from the federally designated Spinal Cord Injury Model Systems demonstrate that the annual risk for DVT among chronic SCI patients (1.1% one to six years after injury) is much lower than that for acute SCI patients, and the risk for PE is even lower (0.3%) (Ragnarsson, 1995).…”

“…Similarly, among acute SCI patients managed at the Mayo Clinic from 1976 to 1995, the use of DVT screening was the strongest predictor of a VTE diagnosis, with a risk ratio of 2.8-fold compared with patients not screened (Winemiller, 1999). Three retrospective studies reported a high rate of asymptomatic DVT when routine DUS was performed in SCI patients on transfer to a rehabilitation center (Powell, 1999;Kadyan, 2003;Do, 2013). DVT was detected in 12% of 189 patients, 9% of 92 patients, and 28% of 185 patients on admission to SCI rehabilitation (Powell, 1999;Kadyan, 2003;Do, 2013).…”

“…A number of risk factors have not been consistently found to be related to increased risk of VTE in SCI, including gender, obesity, nonorthopedic injuries, and surgical management (McKinley, 2004;Do, 2013;de Campos Guerra, 2014;Godat, 2015).…”

“…Three retrospective studies reported a high rate of asymptomatic DVT when routine DUS was performed in SCI patients on transfer to a rehabilitation center (Powell, 1999;Kadyan, 2003;Do, 2013). DVT was detected in 12% of 189 patients, 9% of 92 patients, and 28% of 185 patients on admission to SCI rehabilitation (Powell, 1999;Kadyan, 2003;Do, 2013). At Johns Hopkins Hospital, the implementation of DUS screening in trauma patients led to a tenfold increase in the detection of DVT without any reduction in PE; in fact, PE rates increased over the same time period (Haut, 2012).…”