Systematic lower limb phlebography in acute spinal cord injury in 147 patients

Yelnik, A.; Dizien, O; Bussel, B.; Schouman-Claeys, E; Frija, G; Pannier, S; Held, Jean-Pierre

doi:10.1038/sc.1991.36

Cited by 40 publications

(32 citation statements)

References 12 publications

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“…Venous stasis due to forced bedrest and absence of muscle contractions, in¯ammation, frequently present in spinal cord injury patients, are known to promote venous thrombosis. 21,22 The absence of recovery of ®brinolytic potential results in loss of protection against thrombosis. This combination of risk factors explains why prophylactic anticoagulant therapy fails to provide complete protection from DVT in patients with spinal cord injury.…”

Section: Discussionmentioning

confidence: 99%

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury

et al. 1997

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Deep vein thrombosis (DVT) is a frequent event in patients with spinal cord injury, even with prophylactic anticoagulant therapy. Lower limb paralysis is a known major risk factor for venous thrombosis, supposedly due to the venostasis in relation with total immobility. The main goal of this study was to evaluate the endothelial response to anoxia to determine whether recovery of ®brinolytic potential occurs in patients subjected to forced bedrest because of a spinal cord injury and whether this recovery is related to the incidence and/or evolution of DVT. We evaluated vascular endothelium reactivity in the lower limbs no longer submitted to the hydrostatic pressure of the erected position in 15 patients with paraplegia or tetraplegia and in 10 normal volunteers after venous occlusion produced by the application of 10 cm Hg pressure to the lower limb for 15 min comparatively to the upper limb used as reference. Among the 15 patients, 10 whose spinal cord injury had occurred 1 to 6 months earlier were still receiving prophylactic anticoagulant therapy, whereas the ®ve other patients were not receiving prophylactic anticoagulants because the injury dated back 6 months or more. After venostasis, tissue plasminogen activator (tPA) increased signi®cantly in both patients and controls in the upper limb (tPA levels twofold and threefold respectively in controls and patients) but showed no signi®cant changes in the lower limb; prolonged immobility did not allow recovery in the lower limbs of a level of ®brinolytic responsiveness identical to that in the upper limbs. The plasminogen activator inhibitor (PAI 1 ) remained unchanged after anoxia, although wide interindividual variations were seen. Natural coagulation inhibitors and circulating blood stigmates of hypercoagulability were measured. None of the patients had abnormally low levels of coagulation inhibitors (ie, antithrombin III, protein C and protein S levels were normal). Seventy-®ve per cent of patients (prophylactically anticoagulated or not) had very high levels of ®brin degradation products (D. Dimer levels sevenfold to eightfold those of the controls), but all patients had normal levels of thrombinantithrombin complexes and prothrombin fragments 1+2. The permanence of the thrombotic process characterized by an increase in D. Dimer levels without recovery of ®brinolytic potential suggests a proposal for the patients an inde®nite antithrombotic treatment at curative doses.

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Section: Discussionmentioning

confidence: 99%

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury

et al. 1997

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“…Yelnik et al 17 reported no difference between patients with paraplegia and tetraplegia. It is interesting to note that all of our patients with paraplegia with DVT had spastic paralysis.…”

Section: 3710mentioning

confidence: 99%

Deep venous thrombosis in patients with chronic spinal cord injury

Mackiewicz−Milewska

Jung

Kroszczyński³

et al. 2015

The Journal of Spinal Cord Medicine

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Context/Objective: Deep venous thrombosis (DVT) is a well-known complication of an acute spinal cord injury (SCI). However, the prevalence of DVT in patients with chronic SCI has only been reported in a limited number of studies. The aim of our study was to examine the prevalence of DVT in patients with SCI beyond three months after injury. Design: Cross-sectional study. Setting: Rehabilitation Department at the Bydgoszcz University Hospital in Poland. Participants: Sixty-three patients with SCI that were more than 3 months post injury. The patients, ranging in age from 13 to 65 years, consisted of 15 women and 48 men; the mean age of the patients was 32.1 years. The time from injury varied from 4 to 124 months. Outcome measures: Clinical assessment, D-dimer and venous duplex scan. Results: The venous duplex scan revealed DVT in 5 of the 63 patients. The post-injury time in four of the patients varied between 4 and 5 months; one patient was 42 months post-injury. Conclusion: DVT occurred in patients with chronic SCI, mainly by the 6th post injury month.

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“…Deep vein thrombosis (DVT) and pulmonary embolism (PE) remain common complications of spinal cord injury 1 despite widespread use of prophylactic anticoagulant therapy. 2,3 The clinical diagnosis of venous thrombosis is extremely dicult in such patients and the prevalence of thromboembolic complications has varied across studies, 4,5 in particular as a result of dierences in diagnostic methods; in the great majority of the cases, radiologic explorations are necessary particularly ultrasonography and/or phlebography.…”

Section: Introductionmentioning

confidence: 99%

Contribution of D-Dimer determination in the exclusion of deep venous thrombosis in spinal cord injury patients

et al. 1999

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Deep vein thrombosis (DVT) is a common complication of paraplegia despite prophylactic anticoagulant therapy. The diagnosis relies primarily on ultrasonography or phlebography; these investigations are dicult, expensive and can be time-consuming in paraplegic patients. Study Design: To evaluate the usefulness of coagulation activation markers in excluding a diagnosis of DVT, D-Dimers, thrombin-antithrombin complexes, prothrombin fragments (F 1+2 ) and activated factor VIIa. Objectives: To improve the diagnosis of deep venous thrombosis in paraplegic patients. Setting: This collaborative work was done at Raymond PoincareÂ Hospital, Garches, France. Methods: To evaluate the usefulness of coagulation activation markers in excluding a diagnosis of DVT, D-Dimers (D-Di), thrombin-antithrombin (TAT) complexes, prothrombin fragments (F 1+2 ) and activated factor VIIa (FVIIa), were determined in a prospective study of 67 consecutive patients with paraplegia or tetraplegia. Doppler ultrasonography and/or phlebography of the lower limbs and D-Di, TAT, F 1+2 level determination were systematically done in each patient at admission to our rehabilitation unit. Results: Despite prophylactic low molecular weight heparin therapy, six of the 67 patients developed DVT diagnosed by radiologic explorations. D-Di levels measured by a reference ELISA (Asserachrom D-Di, Diagnostica Stago) or a new rapid automated turbidimetric test (STA-Liatest D-Di) were greater than 500 ng/ml in all DVT patients and in 40 non-DVT patients, of whom most had urinary tract infections, osteomas, or pressure sores. D-Di values were normal in only 21/67 patients (31%). The negative predictive value of D-Di in our study was 100% since all DVT patients had D-Di values greater than 500 ng/ml. TAT and F 1+2 levels were not correlated with D-Di levels but also had a negative predictive value of 100%. Comparison of D-Di levels obtained using the two tests showed that results of the reference ELISA were closely correlated to those of the new rapid automated turbidimetric. TAT, F 1+2 , and factor VIIa are not useful for measuring hypercoagulability in paraplegic or tetraplegic patients since no rapid tests for determining these parameters are available. Conclusion: D-Di levels determined using an ELISA or a new rapid automated turbidimetric test have a good negative predictive value for DVT in paraplegic or tetraplegic patients and may reduce the need for Doppler ultrasonography and/or phlebography by 31%.

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Systematic lower limb phlebography in acute spinal cord injury in 147 patients

Cited by 40 publications

References 12 publications

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury

Deep venous thrombosis in patients with chronic spinal cord injury

Contribution of D-Dimer determination in the exclusion of deep venous thrombosis in spinal cord injury patients

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