Venous Thromboembolism After Spinal Cord Injury: Incidence, Time Course, and Associated Risk Factors in 16,240 Adults and Children

Jones, Tracey; Ugalde, Viviane; Franks, Peter; Zhou, Hong; White, Richard

doi:10.1016/j.apmr.2005.07.286

Cited by 117 publications

(95 citation statements)

References 32 publications

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“…Considering the known mechanisms for the onset of DVT, we need to bear in mind that the risk for DVT increases with more severe paralysis and the incidence of DVT is particularly high in patients with complete motor paralysis associated with spinal cord injury. 5,6 In other words, the incidence of DVT is high in paralyzed patients with spinal cord injury; therefore, early detection and treatment are essential in such cases. For early detection, we need to understand the timing associated with DVT onset; however, we have little information regarding the timing of DVT onset.…”

Section: Timing and Incidence Of Dvt In Spinal Cord Injury Patientsmentioning

confidence: 99%

Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy

et al. 2015

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Study Design: Prospective cross-sectional study. Objectives: To investigate the timing of deep vein thrombosis (DVT) onset secondary to spinal cord injury without anticoagulant therapies. Setting: Spinal Cord Injury Center in Hokkaido, Japan. Methods: Between November 2012 and June 2013, patients with spinal cord injury who were admitted to our hospital within 1 day after the injury and treated surgically within 24 h underwent a neurological examination, leg vein ultrasonography and D-dimer test 1, 3, 7, 14 and 28 days after surgery. All patients received treatment with intermittent pneumatic compression and elastic stockings, but without any anticoagulant. Results: DVT developed in 12 patients (11 men and 1 women), with a mean age of 62.2 years (range, 41-80 years; mean age of total sample, 63.2 years (range, 25-78 years)), all distal to the popliteal vein. DVT occurred more often with a more severe paralysis (66.3%, AIS A and B). The median (± standard error) length of time from the operation to DVT detection was 7.5 ± 2.2 days. The mean D-dimer level upon DVT detection was 14.6 ± 11.8 μg ml − 1 , with no significant differences between those who developed DVT and those who did not at any of the time points. Conclusion: These results suggest that DVT can develop at the very-acute stage of spinal cord injury and the incidence increases with a more severe paralysis. DVT detection was more reliable with ultrasonography, which should be used with DVT-preventive measures, beginning immediately after the injury, for the management of patients with spinal cord injury. INTRODUCTIONDeep vein thrombosis (DVT) is one of the most dangerous complications of a spinal cord injury. DVT has a high incidence in patients with spinal cord injury as compared with patients with other diseases 1 with a high mortality rate if complicated by pulmonary embolism. 2 Although prevention, early detection and timely treatment of DVT are important during the management of patients with spinal cord injury, the timing of DVT onset secondary to a spinal cord injury has not yet been determined. In order to clarify these problems, this study aimed to investigate the timing of DVT onset by prospectively analyzing the patients immediately after a spinal cord injury.

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Section: Timing and Incidence Of Dvt In Spinal Cord Injury Patientsmentioning

confidence: 99%

Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy

et al. 2015

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“…12 To account for the effect of multiple injuries, we counted the number of injuries from each body region other than the spine with an AIS of X2, and were categorized as 1 (if only spine), 2, 3 and 4 or more. We classified neurological impairment of TSCI based on the categorization scheme of Jones et al 8 as, (1) …”

Section: Definitionsmentioning

confidence: 99%

“…Epidemiological studies of in-hospital mortality after TSCI have identified important risk factors that include advancing age, 6 lesion type and level of injury, 6 comorbidities 4, 6 and complications such as venous thromboembolism, 7,8 traumatic brain injury 6 and polytrauma 3 with varying strength of association. While there is uniformity in most of the studies regarding the risk of death with advancing age and medical complications, there is discordant association on the effect of comorbid conditions due to different classification schemes.…”

Section: Introductionmentioning

confidence: 99%

Determinants of in-hospital death after acute spinal cord injury: a population-based study

et al. 2012

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Objectives: First, to evaluate the influence of comorbid diseases and concomitant injuries on the risk of in-hospital death after traumatic spinal cord injury (TSCI). Second, to identify the risk characteristics of TSCI patients with likelihood of death. Study design: Population-based retrospective cohort study. Setting: Sixty-two acute care hospitals in South Carolina, USA. Methods: Records of 3389 TSCI patients hospitalized with acute TSCI were evaluated. Days elapsing from the date of injury to date of death established the survival time (T). Cox regression examined risk of in-hospital death as a function of counts of comorbid conditions and injuries along with their joint effects controlling for other covariates. Results: Counts of comorbid conditions and injuries showed dose-dependent risk of death while in-hospital independent of demographical and clinical covariates. Hazard ratios (HR) for counts 3 þ , 2 and 1 comorbid conditions were 2.19 (Po0.001), 1.73 (P ¼ 0.005) and 1.20 (P ¼ 0.322), respectively. For counts of 4 þ , 3 and 2 other injuries were 1.85 (Po0.001), 1.81 (Po0.001) and 1.46 (P ¼ 0.022), respectively. The joint effect of the two was transadditive with statistically significant HR ranging from 1.72-3.14. Conclusion: Counts of comorbid conditions and injured body regions strongly indicate risk of in-hospital death after TSCI and their joint effects elicited dose-dependent gradient independent of demographical and clinical covariates. Assessing risk of in-hospital death based on joint use of counts of comorbid diseases and injuries is highly informative to target TSCI patients at high risk of dying.

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“…6,18,19 Similarly, studies conducted in neighboring India to asses the risk of DVT in patients undergoing hip and knee arthroplasties reported the incidence of DVT to be 6.1% (Bagaria et al 4 ) and 2.8% ( Jain et al 20 ), respectively, which is significantly lower than the incidence in the West. 8,9 In our study, DVT was found to be more common in patients who had complete SCI and were immobilized for a longer period of time than the patients having incomplete injury or no neurological deficit and who were mobilized earlier. A recent report of complications in a different cohort of 194 SCI earthquake survivors found that only 3 patients (2%) developed DVT, with one dieing of a pulmonary embolism.…”

Section: Discussionmentioning

confidence: 52%

“…7 The prevalence of DVT following acute SCI in Western populations ranges from 5.4 to 28% with thromboprophylaxis. [8][9][10] The earthquake that struck Pakistan on the 8th October 2005 was a devastating tragedy that left 73 000 dead and 126 000 injured. Owing to the absence of a national trauma registry, an accurate assessment of the total number of cases of SCI was difficult to determine, but the estimates range from 650 to 750.…”

Section: Introductionmentioning

confidence: 99%

The prevalence of deep vein thrombosis in a cohort of patients with spinal cord injury following the Pakistan earthquake of October 2005

et al. 2008

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Study design: Prospective observational study. Objectives: To assess the prevalence of symptomatic deep vein thrombosis (DVT) in earthquake survivors with spinal cord injury (SCI). Settings: Rawalpindi, Pakistan, in the months after the October 2005 earthquake. Methods: Earthquake survivors (n ¼ 187) with acute SCI were enrolled after verbal informed consent. Information on mechanism of injury, mode of evacuation, associated injuries was gathered, and a detailed clinical and radiological assessment was performed. They were followed for 10 weeks for clinical signs and symptoms suggestive of DVT. Case with clinical suspicion of a DVT underwent a duplex scan of both legs to confirm the diagnosis. The influence of age, gender, American Spinal Injury Association (ASIA) grade and lower limb fractures on occurrence of DVT was determined. Results: There were 80 men and 107 women with a mean age of 28.3 ± 12.4 years. Seventeen patients were clinically suspected to have a DVT and ultrasound was positive in nine (4.8%). There was no influence of age (P ¼ 0.4), gender (P ¼ 0.4), ASIA grade (P ¼ 0.1) or presence of a lower limb fracture (P ¼ 0.6) on the occurrence of a DVT. Conclusion: This study adds further evidence to support the belief that the incidence of DVT in Southeast Asian patients with an SCI is lower than the reported incidence in the West. It may not be necessary to apply the recommendations for DVT prophylaxis in Caucasians with SCI to other groups, including Southeast Asians.

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Venous Thromboembolism After Spinal Cord Injury: Incidence, Time Course, and Associated Risk Factors in 16,240 Adults and Children

Cited by 117 publications

References 32 publications

Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy

Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy

Determinants of in-hospital death after acute spinal cord injury: a population-based study

The prevalence of deep vein thrombosis in a cohort of patients with spinal cord injury following the Pakistan earthquake of October 2005

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