Venous Thromboembolism Following Spinal Cord Injury

Arch Phys Med Rehabil, 2009 · DOI: 10.1016/j.apmr.2008.09.557 · Published: February 1, 2009

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are significant causes of illness and death in patients with spinal cord injuries (SCI). The review focuses on interventions for treating venous thromboemboli in SCI individuals. The diagnosis of DVT and PE can be unreliable clinically, necessitating diagnostic testing. Common tests include venous ultrasound, venography, and D-dimer assay for DVT, and ventilation/perfusion scans and spiral CT scans for PE. The risk of DVT in SCI patients is high due to hypercoagulability, stasis, and intimal injury. While calf DVTs are less concerning, proximal DVTs are a primary source of concern.

Study Duration

Not specified

Participants

Various studies with at least 3 subjects and at least 50% having SCI

Evidence Level

Systematic Review

Key Findings

1
Low molecular weight heparin (LMWH) is more effective than unfractionated heparin (UFH) in preventing venous thromboembolic events and has a lower risk of bleeding complications.
2
An adjusted, higher dose of subcutaneous heparin is more effective than a fixed dose of 5000 IU subcutaneous heparin every 12 hours, but is associated with a higher risk of bleeding complications.
3
Sequential pneumatic compression devices or gradient elastic stockings reduce the risk of venous thromboemboli post-SCI. Rotating treatment tables also reduce the incidence of venous thrombi in acute SCI patients.

Research Summary

This systematic review examined the treatment of venous thromboembolism in SCI patients, finding good evidence for pharmacological prophylaxis. Research into non-pharmacological prophylaxis or treatment specifically in SCI patients is lacking. Guidelines for DVT prophylaxis in SCI include sequential compression devices for 2 weeks and anticoagulants for 8 to 12 weeks after injury. LMWH is suggested as the standard of treatment due to its effectiveness and lower bleeding risk. Combining treatments, such as pharmacologic and mechanical methods, may have an additive benefit, though current evidence suggests pharmacologic measures are more important. Physical measures help reduce stasis in immobilized lower extremities.

Practical Implications

Pharmacological Prophylaxis

LMWH should be considered the standard of care for VTE prophylaxis in SCI patients due to its superior efficacy and safety profile compared to UFH.

Combined Treatment Strategies

Consider combining pharmacologic (LMWH) with mechanical prophylaxis (sequential compression devices, gradient elastic stockings) for enhanced VTE prevention in SCI patients.

Early Intervention

Initiate VTE prophylaxis as early as possible after SCI, ideally within 72 hours of injury, to maximize effectiveness and minimize the risk of thromboembolic events.

Study Limitations

1
Limited research on non-pharmacological prophylaxis specifically in SCI patients
2
Lack of research examining the treatment of newly-diagnosed venous thromboembolism in SCI patients
3
The quality of evidence for combined DVT prophylaxis measures is not strong

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