Venous thromboembolism: Exploring incidence and utility of screening in spinal cord injury

The Journal of Spinal Cord Medicine, 2024 · DOI: 10.1080/10790268.2023.2207063 · Published: January 1, 2024

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and serious complication following spinal cord injury (SCI). Patients with SCI face a higher risk of VTE compared to others with trauma. Diagnosing VTE in SCI patients is challenging due to leg swelling and reduced sensation, which can mask symptoms. Early diagnosis is crucial to reduce morbidity and mortality. This study assessed the incidence of VTE at different points: in the acute care hospital, upon admission to rehabilitation, and during rehabilitation. It also looked at the impact of anticoagulation treatment on PE risk and bleeding complications.

Study Duration

2 Years

Participants

228 patients with spinal cord injury

Evidence Level

Not specified

Key Findings

1
A high percentage (70%) of DVTs were identified through screening ultrasound upon admission to rehabilitation, suggesting the value of this practice.
2
Therapeutic anticoagulation for DVTs was associated with a low incidence of pulmonary embolism (PE), specifically zero incidence of PE among those who remained on continuous therapeutic anticoagulation.
3
Several risk factors were identified for the development of VTE, including age, BMI, rehabilitation length of stay, injury etiology, spinal cord-related surgery, and history of IVC filter placement.

Research Summary

The study aimed to determine the incidence of VTE at three different time points, the incidence of DVT converting to PE, the bleeding risk from anticoagulation, and secondary risk factors for DVT development. A high rate of VTEs were diagnosed upon admission to acute rehabilitation via screening duplex ultrasonography. The study supports performing screening duplex ultrasound of paretic extremities on admission to rehabilitation to determine the presence of DVT and guide anticoagulation.

Practical Implications

Screening on Rehabilitation Admission

Routine screening for DVT via ultrasound upon admission to rehabilitation should be considered, as it can detect a significant number of asymptomatic cases.

Therapeutic Anticoagulation

Therapeutic anticoagulation appears to be effective in preventing PE in SCI patients with DVT, with an acceptable risk of bleeding complications.

Risk Factor Management

Clinicians should be aware of the identified risk factors for VTE in SCI patients and consider them in management and prevention strategies.

Study Limitations

1
Retrospective nature of the study
2
Single-center study, potentially limiting generalizability
3
Lack of data on whether patients were symptomatic or asymptomatic at the time of screening

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