Risk factors for venous thromboembolism in patients with spinal cord injury: A single-center Turkish study

Year 2022, Volume: 12 Issue: 4, 515 - 519, 31.07.2022

Hüma Bölük Şenlikci , Sevgi İkbali Afşar

https://doi.org/10.16899/jcm.900384

Abstract

Objective
Spinal cord injury (SCI) occurs due to trauma or non-traumatic conditions may be associated with comorbidities related to cardiovascular system and higher risk for venous thromboembolism (VTE). This study aimed to identify risk factors for VTE in patients with SCI.
Material and Methods
The study included 326 patients diagnosed as SCI that were admitted to the inpatient tertiary research hospital rehabilitation clinic and enrolled in a conventional rehabilitation program. The data were collected retrospectively. Risk factors for developing VTE were identified.
Results
There were no significant differences in age, comorbidities or SCI etiology between the patients with and without VTE. The groups differed significantly in gender, level of injury and duration of SCI. Risk factor for VTE were only level of injury.
Conclusions
The present findings show that paraplegic injury level may be considered risk factor for developing VTE in SCI patients. It should be considered when approaching the possibility of VTE in SCI patients.

Keywords

Spinal cord injury, venous thromboembolism, deep venous thromboembolism, pulmonary embolism

Project Number

KA12/265

Spinal Kord yaralanmalı hastalarda venöz tromboembolizm için risk faktörlerinin ortaya konması: Tek merkezli Türkiye verileri

Abstract

Amaç
Spinal kord yaralanması travmatik veya travmatik olmayan nedenlerle oluşur ve kardiyovasküler sistem hastalıkları ve yüksek venöz tromboembolizm (VT) riski ile ilişkilidir. Bu çalışmanın amacı spinal kord yaralanmalı hastalarda VT ile ilişkili risk faktörlerini ortaya koymaktır.
Gereç ve Yöntem
Çalışma spinal kord yaralanması tanısı olan ve 3. Basamak araştırma hastanesi rehabilitasyon kliniğine başvurup konvansiyonel rehabilitasyon programına dahil edilen 326 hastadan oluşmaktadır. Veriler retrospektif olarak toplanmıştır. Venöz tromboembolizm için risk faktörleri ortaya konmuştur.
Bulgular
Yaş, ek sistemik hastalıklar veya spinal kord yaralanması etiyolojisi açısından VT olan ve olmayan gruplar arasında fark yoktur. Gruplar cinsiyet, yaralanma seviyesi ve yaralanma süresi açısından farklılık göstermektedir. Tek risk faktörü yaralanma seviyesidir.
Sonuç
Bu çalışmada spinal kord yaralanmalı hastalarda yaralanma seviyesi risk faktörü olarak bulunmuştur. Spinal kord yaralanmalı hastalara VT açısından yaklaşımda akılda bulundurulmalıdır.

Keywords

Spinal kord yaralanması, venöz tromboembolizm, derin venöz tromboembolizm, pulmoner embolizm

Project Number

KA12/265

References

• Referans1. Maung AA, Schuster KM, Kaplan LJ, et al. Risk of venous thromboembolism after spinal cord injury: not all levels are the same. J Trauma 2011;71:1241-5.
• Referans2. Hagen EM, Rekand T, Grønning M, et al. Cardiovascular complications of spinal cord injury. Tidsskr Nor Laegeforen 2012;132:1115-20.
• Referans3. Merli GJ, Crabbe S, Paluzzi RG, et al. Etiology, incidence, and prevention of deep vein thrombosis in acute spinal cord injury. Arch Phys Med Rehabil 1993;74:1199-205.
• Referans4. Piran S, Schulman S. Incidence and risk factors for venous thromboembolism in patients with acute spinal cord injury: A retrospective study. Thromb Res 2012;147:97-101.
• Referans5. DiGiorgio AM, Tsolinas R, Alazzeh M, et al. Safety and effectiveness of early chemical deep venous thrombosis prophylaxis after spinal cord injury: pilot prospective data. Neurosurg Focus 2017;43:E21.
• Referans6. Clements R, Churilov L, Wahab AL, et al. Exploratory analysis of factors associated with venous thromboembolism in Victorian acute traumatic spinal cord-injured patients 2010-2013. Spinal Cord. 2017;55:74-8.
• Referans7. Chung WS, Lin CL, Chang SN, et al. Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with spinal cord injury: a nationwide cohort prospective study. Thromb Res. 2014;133:579-84.
• Referans8. Alabed S, Belci M, Van Middendorp JJ, et al. Thromboembolism in the Sub-Acute Phase of Spinal Cord Injury: A Systematic Review of the Literature. Asian Spine J. 2016;10:972-81.
• Referans9. Küçükdeveci AA, Yavuzer G, Elhan AH, et al. Adaptation of the Functional Independence Measure for use in Turkey. Clin Rehabil. 2011;15:311‐9.
• Referans10. Holden MK, Gill KM, Magliozzi MR. Gait assessment for neurologically impaired patients. Standards for outcome assessment. Phys Ther.1986; 66:1530-9.
• Referans11. Akpinar P, Atici A, Ozkan FU, et al. Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in patients with spinal cord injuries. Spinal Cord. 2017;55:944-49.
• Referans12. Meyer G. Effective diagnosis and treatment of pulmonary embolism: Improving patient outcomes. Arch Cardiovasc Dis. 2014;107:406‐14.
• Referans13. Piran S, Schulman S. Thromboprophylaxis in Patients with Acute Spinal Cord Injury: A Narrative Review. Semin Thromb Hemost. 2019;45:150‐6.
• Referans14. Eichinger S, Eischer L, Sinkovec H, et al. Risk of venous thromboembolism during rehabilitation of patients with spinal cord injury. PloS One. 2018;28;13:e0193735.
• Referans15. Mlaco A, Mlaco N, Bejtovic D, et al. Venous Thromboembolism During Ten-year Follow up on Clinical Center University of Sarajevo. Mater Sociomed. 2019;31:84-7.
• Referans16. Hwang HG, Choi WI, Lee B, et al. Incidence and Risk Factors of Recurrent Venous Thromboembolism after Pulmonary Embolism. Tuberc Respir Dis [Seoul]. 2019;82:341-47.
• Referans17. Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003; 107: I9-26.
• Referans18. Hopman MT, Nommensen E, van Asten WN, et al. Properties of the venous vascular system in the lower extremities of individuals with paraplegia. Paraplegia.1994; 32 :810‐6.
• Referans19. Green D, Hartwig D, Chen D, et al. Spinal Cord Injury Risk Assessment for Thromboembolism [SPIRATE Study]. Am J Phys Med Rehabil. 2003;82:950-6.
• Referans20. Born CT, Gil JA, Goodman AD. Joint Contractures Resulting From Prolonged Immobilization: Etiology, Prevention, and Management. J Am Acad Orthop Surg. 2017;25:110-6.
• Referans21. Zee AA, van Lieshout K, van der Heide M, et al. Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization. Cochrane Database Syst Rev. 2017;8:CD006681.
• Referans22. Jones T, Ugalde V, Franks P, et al. Venous thromboembolism after spinal cord injury: incidence, time course, and associated risk factors in 16,240 adults and children. Arch Phys Med Rehabil 2005;86: 2240-7.
• Referans23. Selassie AW, Varma A, Saunders LL. Current trends in venous thromboembolism among persons hospitalized with acute traumatic spinal cord injury: does early access to rehabilitation matter? Arch Phys Med Rehabil 2011;92: 1534-40.