Usefulness of D-dimer and Ultrasonography Screening for Detecting Deep Vein Thrombosis in Patients with Spinal Cord Injury Undergoing Rehabilitation

Abstract

Patients with spinal cord injury (SCI) are at an increased risk of deep vein thrombosis (DVT). This study aims at assessing usefulness of D-dimer and compressive Doppler ultrasonography (CDUS) for detecting DVT in patients undergoing rehabilitation at various time-points post-SCI. One-hundred forty-five patients were divided into three groups based on time elapsed since SCI: I (≥3 weeks to 3 months), II (≥3 to 6 months), and III (≥6 months). On admission, D-dimer plasma level measurement and CDUS of the lower limbs venous system were performed. DVT was diagnosed using CDUS in 15 patients (10.3% of entire group), more frequently in group I (22.2% of group) and II (11.7%) compared to group III (1.5%). Most DVT patients received thromboprophylaxis (80%) and were asymptomatic or mildly symptomatic (60%). Median D-dimer was elevated in patients with DVT from all groups, and also patients without DVT from groups I and II, but not group III. D-dimers were higher in patients with DVT than without DVT in the entire group (p = 0.001) and group I (p = 0.02), but not in groups II and III. The risk of DVT in SCI patients undergoing rehabilitation and thromboprophylaxis including asymptomatic or mildly symptomatic cases, is high within 6 months post-injury, and especially within 3 months. Measurement of D-dimer level should be complemented by routine CDUS for detecting DVT within 6 months post-SCI. Over 6 months, the usefulness of D-dimer screening alone is better for DVT detection.

Trauma-induced pulmonary thromboembolism: What's update?

“…D-dimer screening alone for DVT detection revealed a better effect with the during of >6 months, compared with that within the periods of 3 weeks–3 months and 3–6 months. 62 …”

“…Weekly venous compression duplex should be considered in patients at a high risk of VTE who is unable to start or maintain on pharmacologic prophylaxis as this is associated with a reduced PE rate. 62 …”

Intramuscular Hematomas in Patients Receiving Prophylaxis or Anticoagulant Treatment after Spinal Cord Injury (SCI)—A Rare Complication: Description of Seven Cases and a Literature Analysis

“…The time at which prophylaxis is started should be as early as possible, but after the risk of bleeding complications has decreased [ 2 , 7 ]. Despite the use of prophylaxis in the form of LMWH, complications of DVT and PE occur in this group of patients, especially in the early phase after the injury, i.e., up to three months, which then requires full-dose anticoagulant therapy [ 8 ]. Anticoagulant treatment is associated with the possibility of bleeding, sometimes even becoming life-threatening.…”

Development of a hypercoagulable-hypofibrinolytic state early after spinal cord injury

“…In context of future cardiovascular disease, undiagnosed, indolent, subclinical coagulation and brinolytic dysfunction early after injury, may also be an important contributor to major vascular events decades later in life. Studies assessing coagulation and brinolytic factors in individuals with subacute and chronic SCI have demonstrated con icting results (11,(16)(17)(18).…”