Risk of venous thromboembolism during rehabilitation of patients with spinal cord injury

PLoS ONE, 2018 · DOI: https://doi.org/10.1371/journal.pone.0193735 · Published: March 28, 2018

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

Patients with spinal cord injuries are at an increased risk of developing blood clots, specifically venous thromboembolism (VTE), and bleeding complications. The study found that a high level of D-dimer upon admission to the rehabilitation clinic was associated with an increased risk of VTE. Strategies are needed to identify patients at risk of VTE and bleeding during rehabilitation, and direct oral anticoagulants should be explored as a potential treatment option.

Study Duration

5.1±2.1 months

Participants

185 patients with spinal cord injury

Evidence Level

Not specified

Key Findings

1
The probability of developing VTE after 6 months of rehabilitation was 2% (95% CI 0–4.4%) after excluding patients with VTE detected within 2 days of admission.
2
High D-Dimer upon admission was associated with risk of VTE (adjusted HR 2.3, 95% CI 1.4–4.1).
3
Of 24 bleedings, 14 (64%) occurred at the heparin injection site.

Research Summary

This study evaluated the risk of venous thromboembolism (VTE) and bleeding events in spinal cord injury (SCI) patients during rehabilitation. The study found that SCI patients are at risk of VTE and bleeding during rehabilitation. Strategies need to be developed to identify these patients in order to initiate adequate anticoagulation, and direct oral anticoagulants should be explored.

Practical Implications

Risk Stratification

Develop strategies to identify SCI patients at high risk of VTE and bleeding during rehabilitation.

Anticoagulation Strategies

Explore the use of direct oral anticoagulants (DOACs) as a convenient and effective alternative to LMWH for thromboprophylaxis.

VTE Screening

Consider the relevance of VTE screening in SCI patients, particularly early in the rehabilitation phase, given the potential for atypical clinical presentation.

Study Limitations

1
The study may lack power to detect significant effects due to the low event rate of VTE.
2
The exclusion of patients with VTE or major bleeding at the primary care center may have influenced the event rates.
3
As all patients received LMWH thromboprophylaxis, there is no information on the thrombotic risk in the absence of pharmacologic thromboprophylaxis.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury