Intramuscular Hematomas in Patients Receiving Prophylaxis or Anticoagulant Treatment after Spinal Cord Injury (SCI)—A Rare Complication: Description of Seven Cases and a Literature Analysis

Biomedicines, 2023 · DOI: 10.3390/biomedicines11041142 · Published: April 10, 2023

Spinal Cord Injury Pharmacology Orthopedics

Simple Explanation

Spinal cord injuries increase the risk of blood clots, even with preventative treatments like low-molecular-weight heparin (LMWH). If clots occur, stronger anticoagulants are needed, but these can cause bleeding. This paper describes seven cases of intramuscular hematomas in SCI patients undergoing rehabilitation. The patients developed spontaneous intramuscular hematomas (SMHs) without significant injuries. Four were on anticoagulant therapy for deep vein thrombosis (DVT), and three were on prophylactic anticoagulation. The main symptom was sudden limb swelling without pain. The hematomas were treated conservatively, with some patients needing blood transfusions due to hemoglobin drops. Anticoagulation treatments were modified upon hematoma diagnosis, either switching to LMWH or discontinuing treatment altogether.

Study Duration

2011–2022

Participants

152 patients with traumatic (TSCI) and non-traumatic SCI (NTSCI)

Evidence Level

Case Report and Literature Analysis

Key Findings

1
Intramuscular hematomas are rare complications after SCI, often presenting as sudden limb swelling.
2
Ultrasound-based diagnostics are crucial for identifying hematomas in SCI patients with limb swelling.
3
Monitoring hemoglobin levels and hematoma size is essential for managing intramuscular hematomas and modifying anticoagulation treatments appropriately.

Research Summary

This study describes seven cases of spontaneous intramuscular hematomas (SMHs) in patients with spinal cord injuries (SCIs) undergoing rehabilitation. The patients were either receiving anticoagulant therapy for deep vein thrombosis (DVT) or antithrombotic prophylaxis. The primary symptom observed was sudden swelling of the limb without accompanying pain. Diagnosis was confirmed through ultrasound. Treatment was primarily conservative, but some patients required blood transfusions due to significant decreases in hemoglobin levels. The study concludes that intramuscular hematomas are rare but important complications to consider in SCI patients. Early diagnosis via ultrasound and monitoring of hemoglobin levels are crucial for appropriate management, including possible modification of anticoagulation treatment.

Practical Implications

Diagnostic Awareness

Clinicians should consider intramuscular hematoma in the differential diagnosis of limb swelling in SCI patients, even in the absence of pain.

Monitoring Protocols

Implement routine ultrasound and hemoglobin level monitoring for SCI patients on anticoagulation therapy or prophylaxis who present with limb swelling.

Treatment Modification

Be prepared to modify or discontinue anticoagulation treatment based on hematoma diagnosis, balancing the risk of VTE recurrence against bleeding complications.

Intramuscular Hematomas in Patients Receiving Prophylaxis or Anticoagulant Treatment after Spinal Cord Injury (SCI)—A Rare Complication: Description of Seven Cases and a Literature Analysis

Simple Explanation

Key Findings

Research Summary

Practical Implications

Diagnostic Awareness

Monitoring Protocols

Treatment Modification

Study Limitations

Your Feedback

Was this summary helpful?

Intramuscular Hematomas in Patients Receiving Prophylaxis or Anticoagulant Treatment after Spinal Cord Injury (SCI)—A Rare Complication: Description of Seven Cases and a Literature Analysis

Simple Explanation

Key Findings

Research Summary

Practical Implications

Diagnostic Awareness

Monitoring Protocols

Treatment Modification

Study Limitations

Your Feedback

Was this summary helpful?