Eﬀects of Four-Week Rehabilitation Program on Hemostasis Disorders in Patients with Spinal Cord Injury

Journal of Clinical Medicine, 2020 · DOI: 10.3390/jcm9061836 · Published: June 12, 2020

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

This study investigates how a four-week rehabilitation program affects blood clotting and related issues in people with spinal cord injuries (SCI). The study measured several factors related to blood clotting before and after the program to see if there were any changes. The patients were divided into groups based on how long ago their spinal cord injury occurred. The researchers measured substances in the blood that are related to blood clotting and the breakdown of clots. The study found that rehabilitation led to some changes in these blood factors, but overall, it didn't reduce the activation of the blood clotting system. However, it did decrease levels of a substance called D-dimer, which indicates the breakdown of blood clots.

Study Duration

4 weeks

Participants

78 in-patients with SCI

Evidence Level

Not specified

Key Findings

1
Rehabilitation resulted in an increase in TF in group III (patients >6 months post-SCI), and a decrease in TFPI and PLT in group II (3-6 months post-SCI) as well as AT in group I (3 weeks-3 months post-SCI).
2
Compared to a control group without SCI, TF, TFPI, and TAT were significantly higher in all SCI groups both before and after rehabilitation.
3
All SCI groups had elevated D-dimer, which decreased after rehabilitation in the whole study group and group I.

Research Summary

This study assessed the eﬀects of a 4-week rehabilitation program on hemostasis disorders in patients with SCI. No decrease in activation of TF-dependent coagulation was observed after a 4-week rehabilitation regardless of time elapsed since SCI. D-dimer levels decreased signiﬁcantly, which may indicate reduction of high ﬁbrinolytic potential, especially when rehabilitation was done <3 months after SCI.

Practical Implications

VTE Risk Persists

Patients with SCI show a continued activation of coagulation and fibrinolytic system long term after injury despite participation in a four-week rehabilitation program, implying a persisting risk of VTE events.

Individualized Rehab Programs

The study's findings suggest that the modalities and timing of rehabilitation programs should be individualized based on the time elapsed since SCI to address the specific hemostasis disorders present.

Further Research Needed

Further studies are needed with longer-term follow-up and larger groups of SCI patients, including those at a higher risk of VTE complications in the acute phase of SCI, to identify the prognostic markers for VTE events and address the mechanisms of hemostasis disorders.

Study Limitations

1
There was no control group that included SCI patients who did not undergo rehabilitation due to the diﬃculty of accessing such patients.
2
Difficulty accessing SCI patients who did not undergo rehabilitation, especially in the subacute phase.
3
Severe complications in patients who do not undergo rehabilitation may preclude exercising.

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