Thromboembolism in the Sub-Acute Phase of Spinal Cord Injury: A Systematic Review of the Literature

Abstract

To review the evidence of thromboembolism incidence and prophylaxis in the sub-acute phase of spinal cord injury (SCI) 3–6 months post injury. All observational and experimental studies with any length of follow-up and no limitations on language or publication status published up to March 2015 were included. Two review authors independently selected trials for inclusion and extracted data. Outcomes studied were incidence of pulmonary embolism (PE) and deep vein thrombosis (DVT) in the sub-acute phase of SCI. The secondary outcome was type of thromboprophylaxis. Our search identified 4305 references and seven articles that met the inclusion criteria. Five papers reported PE events and three papers reported DVT events in the sub-acute phase of SCI. Studies were heterogeneous in populations, design and outcome reporting, therefore a meta-analysis was not performed. The included studies report a PE incidence of 0.5%–6.0% and DVT incidence of 2.0%–8.0% in the sub-acute phase of SCI. Thromboprophylaxis was poorly reported. Spinal patients continue to have a significant risk of PE and DVT after the acute period of their injury. Clinicians are advised to have a low threshold for suspecting venous thromboembolism in the sub-acute phase of SCI and to continue prophylactic anticoagulation therapy for a longer period of time.

Early chemoprophylaxis is associated with decreased venous thromboembolism risk without concomitant increase in intraspinal hematoma expansion after traumatic spinal cord injury

“…Fourth, no patients were followed up after hospital discharge, and the risk of VTE in SCI patients may continue to be elevated months after injury. 26 Finally, we did not account for held or missed doses of heparinoids or aspirin after patients met the criteria for chemoprophylaxis initiation (>24 hours of continuous therapy). Since we dichotomized patients into groups based on initiation of prophylaxis within 48 hours, missed doses may have had an effect on the primary analysis in early prophylaxis patients who had a pause in their therapy.…”

WeMPiC protocol to prevent Deep Venous Thrombosis in patients with neurosurgical diseases

“…Sample size of the cohort was calculated with power of 80% and 95% confi dence interval. Due to large variability in incidence of DVT in patient with neurosurgical diseases (ranging from 2 to 21.3%), 1,2,3,4 incidence reported for TBI i.e. 16.9% 3 was used as incidence in population.…”

“…eep venous thrombosis (DVT) is known to occur in 2-8% of patients with spine injuries, 9.7% in Sub-arachnoid hemorrhages (SAH), 16.9% in traumatic brain injuries (TBI) and highest in brain tumours (21.3%). 1,2,3,4 Neurosurgical patients due to poor sensorium and weakness are often bed ridden exposing them to risk of DVT and consequent pulmonary embolism (PE). Without prophylaxis, incidence of DVT is estimated to be 60%.…”

Case report – Gluteal hematoma in two spinal cord patients on enoxaparin for venous thromboembolism prophylaxis: evidence needed for a wiser choice

“…Even though the risk of VTE decreases during the first 3 months after the spinal cord injury, it might still be almost twice as high as in the general population after 3 years and 20% higher after 8 years in outpatients [17,18]. A systematic review of studies with varying VTE-prophylaxis strategies reports a DVT incidence of up to 8% in the sub-acute phase of the SCI [19]. There are few reports regarding the risk of VTE in individuals with chronic SCI admitted to rehabilitation and the most current guidelines contain no recommendations in favor or against pharmacological prophylaxis in this scenario, suggesting that these decision-making processes were based on clinical experience [20].…”