Venous Thromboembolism is Associated With Lack of Vitamin D Supplementation in Patients With Spinal Cord Injury and Low Vitamin D Levels

Abstract

Background: The role of vitamin D in the pathogenesis of venous thromboembolism (VTE) and prevalence of low vitamin D (LVitD) in spinal cord injury (SCI) has motivated vitamin D testing and supplementation. This is an exploratory study of data collected at a time before the routine clinical practice of vitamin D supplementation, allowing for evaluation of the natural history of vitamin D levels in patients with SCI. Objective: To determine if vitamin D supplementation in persons with SCI and LVitD levels is associated with decreased prevalence of VTE. Design: Retrospective cohort study. Setting: Rehabilitation Center at a Level I Trauma Center. Participants: Patients with SCI admitted to acute inpatient rehabilitation (N = 282). Main Outcome Measures: VTE prevalence in patients with LVitD levels, grouped by presence or absence of vitamin D supplementation. Results: Of the acute inpatient SCI population, 80% (227/282) of patients demonstrated vitamin D levels <30 ng/mL (LVitD). Although the incidence of VTE was almost double in the LVitD group, 19% (43/227) of the patients in the LVitD group had VTE versus 9% (5/55) of patients with vitamin D levels ≥30 ng/mL (normal VitD [NVitD]); this difference was not statistically significant (P = .108, Cramer's V = .104). When the role of vitamin D supplementation was analyzed, individuals in the LVitD group who received no vitamin D supplementation (LVitDSuppNegative) had a higher incidence of VTE (statistically significant) compared to the LVitD group with vitamin D supplementation (LVitDSuppPositive) (24% [42/178] vs. 2% [1/49]) (P < .001, Cramer's V = .226). In post hoc exploratory analyses, the VTE rate of patients in the LVitDSuppNegative group was noted to be significantly higher than that in all other patient groups combined (P < .001, Cramer's V = .229). A binary logistic regression model incorporating clinical covariates also showed this grouping to be significant. Conclusion: A significant association appears to exist between lack of vitamin D supplementation and VTE occurrence in persons with acute SCI and LVitD levels.

Impact of vitamin D on the prognosis after spinal cord injury: A systematic review

“…), which serve as adjunctive antithrombotic agents (62,63). In a retrospective cohort study involving 282 acute SCI patients, a higher incidence of venous thromboembolism was noted in the subjects with VitD levels <30 ng/ml and an absence of VitD supplementation, which was consistent with the findings in other neurological injuries (28,64).…”

“…Ultimately, 35 studies were included for the further systematic review and meta-analysis and presented in the supplemental material. There were 21 studies showing post-SCI VitD status ( Table 1 , ( 22 – 34 ) and Table 2 , ( 35 – 42 )), seven studies regarding the adverse effects associated with a low level of VitD ( Table 3 , ( 22 , 23 , 27 , 28 , 33 , 43 , 44 )), eight studies that evaluated the potential therapeutic effect of VitD supplement ( Table 4 ( 17 , 35 , 45 – 50 )), and five non-human experimental researches exploring the underlying mechanism of VitD after SCI ( Table 5 , ( 51 – 55 )).…”

“…Through this systematic literature search, we found seven eligible studies regarding on the post-SCI complications which might be associated with low levels of VitD ( Table 3 ). The potential adverse impact included poor physical function ( 23 ), depressive symptoms ( 43 ), venous thromboembolism ( 28 ), heterotopic ossification and hyperparathyroidism ( 44 ), chest and respiratory symptoms ( 22 , 27 , 33 ).…”

Influence of Vitamin D Status on the Maintenance Dose of Warfarin in Patients Receiving Chronic Warfarin Therapy

“…Accumulative data from the clinical reports are increasingly reporting a strong negative relationship between serum levels of 25-hydroxyvitamin D and the development of venous thromboembolism, suggesting inadequate vitamin D levels may increase the risk of venous thromboembolism [ 39 – 42 ]. Consistent with this evidence, several epidemiological studies have highlighted a seasonal pattern for the occurrence of thrombotic events, as the risk of thrombotic events is greater in the winter months compared to the summer months, which is thought to be related to the seasonal variation in vitamin D status [ 43 – 45 ].…”