Hemostatic parameters in patients with spinal cord injury in subacute and chronic phase of the rehabilitation

The Journal of Spinal Cord Medicine, 2021 · DOI: 10.1080/10790268.2019.1708600 · Published: January 1, 2021

Spinal Cord Injury Cardiovascular Science

Simple Explanation

This study investigates blood clotting factors in patients with spinal cord injuries (SCI) during their rehabilitation. It aims to understand how these factors change over time after the injury. The study measures specific markers in the blood, such as D-dimer, tissue factor (TF), and tissue factor pathway inhibitor (TFPI), to assess the balance between blood clotting and clot breakdown in SCI patients. The findings could help doctors better understand the risk of blood clots in SCI patients and potentially improve prevention and treatment strategies.

Study Duration

2011 to 2017

Participants

88 SCI patients

Evidence Level

Cross-sectional study

Key Findings

1
D-dimer levels were significantly higher in the subacute phase (3 weeks to 3 months post-SCI) compared to the chronic phases (3-12 months and >12 months post-SCI).
2
TF levels were significantly higher in all SCI groups compared to the control group, regardless of the time elapsed since the injury.
3
TFPI levels were significantly higher in the chronic phase (3-12 months post-SCI) compared to both the chronic phase (>12 months post-SCI) and the control group.

Research Summary

The study assessed hemostatic parameters in SCI patients at different time points post-injury, dividing them into subacute (3 weeks to 3 months) and chronic phases (3-12 months and >12 months). Results indicated that D-dimer levels were highest in the subacute phase, while TF levels remained elevated in all SCI groups compared to controls. TFPI levels were significantly higher in the 3-12 month group compared to later chronic phase and controls. The study suggests that SCI patients have disturbed intravascular hemostasis, with persistent activation of the coagulation system, potentially indicating an increased risk of VTE, especially in the subacute and early chronic phases.

Practical Implications

Risk Assessment

Persistent elevation of TF levels suggests ongoing activation of the coagulation system in SCI patients, indicating a potentially increased risk of venous thromboembolism (VTE).

Monitoring Strategies

D-dimer levels can be used to monitor the fibrinolytic process in SCI patients, especially in the subacute phase, to identify those at higher risk of VTE.

Therapeutic Interventions

Further research is needed to explore targeted therapeutic interventions to manage the disturbed hemostatic equilibrium in SCI patients, particularly focusing on TF and TFPI modulation.

Study Limitations

1
Small sample size may limit the generalizability of the findings.
2
The cross-sectional design prevents establishing causality between hemostatic parameters and VTE risk.
3
Lack of long-term follow-up to assess the actual incidence of asymptomatic DVT.

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