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

Journal of Clinical Medicine, 2021 · DOI: 10.3390/jcm10040689 · Published: February 10, 2021

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

Patients with spinal cord injuries are at a higher risk for developing deep vein thrombosis (DVT). This study investigated how useful D-dimer measurements and ultrasound scans are for finding DVT in these patients during rehabilitation. The study divided patients into three groups based on how long it had been since their spinal cord injury: less than 3 months, 3-6 months, and more than 6 months. D-dimer levels were measured, and ultrasound scans were performed to check for DVT. The results showed that DVT was more common in the early stages after the injury (less than 6 months). The researchers suggest that both D-dimer tests and ultrasound scans should be used together to check for DVT in these patients, especially within the first 6 months after the injury.

Study Duration

2007 to 2018

Participants

145 patients with spinal cord injury undergoing rehabilitation

Evidence Level

Not specified

Key Findings

1
DVT was diagnosed using CDUS in 15 patients (10.3% of total)
2
DVT was the most frequent within the ﬁrst 3 months post-injury (~22% of patients) compared to the period of 3 to 6 months (~12%) and over 6 months (~2%)
3
Median D-dimer levels were elevated in patients with DVT from all groups (i.e., group I, II, and III) and in patients without DVT from group I and II

Research Summary

This study assessed the usefulness of D-dimer and compressive Doppler ultrasonography (CDUS) for detecting DVT in patients undergoing rehabilitation at various time-points post-SCI. 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.

Practical Implications

Routine DVT Screening

Routine DVT screening should be implemented in SCI patients undergoing rehabilitation within the first 6 months post-injury, even if they are receiving thromboprophylaxis.

Combined Diagnostic Approach

D-dimer testing alone is insufficient for accurate DVT diagnosis; CDUS should be used in conjunction with D-dimer testing.

Extended Anticoagulant Therapy

Consider extended anticoagulant therapy (3-6 months or indefinite) for SCI patients with DVT due to persistent chronic risk factors.

Study Limitations

1
Screening for detecting DVT was performed only once during the ﬁrst week of hospitalization
2
New asymptomatic DVT could appear which was not diagnosed due to the lack of clinical symptoms and routine periodic ultrasound screening
3
Further studies on usefulness of D-dimer and CDUS screening for DVT detection are needed for a larger number of SCI patients

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