Risk of venous thromboembolism during rehabilitation of patients with spinal cord injury
نویسندگان
چکیده
BACKGROUND Patients with spinal cord injury (SCI) are at risk of thrombosis and bleeding. Data on the risks during rehabilitation are inconsistent, and thromboprophylactic strategies are heterogeneous. We aimed to evaluate the thrombotic risk and bleeding events of SCI patients during rehabilitation. METHODS We retrospectively collected hospital record data of 263 consecutive SCI patients admitted at a rehabilitation clinic. 78 patients with acute venous thromboembolism (VTE) at the primary center, without acute trauma or lower extremity paresis, less than one month rehabilitation, or reasons for long-term therapeutic anticoagulation, were excluded. All patients received pharmacologic thromboprophylaxis throughout rehabilitation. Primary endpoint was objectively diagnosed VTE; secondary endpoint was bleeding. RESULTS Of 185 patients, 162 (88%) were men; mean age was 47.8 years. 94 patients were tetraplegic, 91 paraplegic. During a mean (±SD) time of 5.1±2.1 months, VTE was diagnosed in 8 patients. After excluding five patients with VTE detected within 2 days after admission, the probability of developing VTE after 6 months of rehabilitation was 2% (95% CI 0-4.4%). Only high D-Dimer upon admission was associated with risk of VTE (adjusted HR 2.3, 95% CI 1.4-4.1). Of 24 bleedings, 14 (64%) occurred at the heparin injection site. Two patients had major bleeding and five had clinically relevant non major bleeding. CONCLUSION 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. Direct oral anticoagulants, which have a favourable risk-benefit profile and are convenient, should be explored.
منابع مشابه
Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.: Consortium for Spinal Cord Medicine.
متن کامل
Effect of Intravenous Injection of Erythropoietinon Hospitalization Period in Patients with Acute Spinal Cord Trauma
Background & Aim: Spinal cord injury (SCI) has a very long history, and its cases form a large proportion of patients admitted to trauma centers in Iran. Studies show that repair after spinal cord injury can be done. In fact, many pharmaceutical agents, such as erythropoietin (EPO), are applied to reduce secondary injury following the initial disorder and to maintain the nerve tissue. Methods &...
متن کاملVenous Thromboembolism and Pressure Ulcers in Acute Spinal Cord Injury: A Retrospective Review
Patients with acute spinal cord injury (SCI) are at high risk of development of complications such as venous thromboembolism (VTE) and pressure ulcers. Clinical guidelines recommend certain preventative and prophylactic strategies in order to reduce the risk of such complications. We aimed to assess the incidence of VTE and pressure ulcers in patients with SCI presenting to a level I trauma cen...
متن کاملIncidence of Spinal Cord Injury in Traumatic Patients Admitted to a Trauma Referral Center in Guilan
Background & Aim: Patients with spinal cord injury (SCI) impose a heavy burden on health care system. Awareness on prevalence and incidence of SCI is important because this would show the necessity of prevention. This study aimed to investigate the epidemiology and types of traumatic spinal cord injuries in a trauma referral center in Guilan. Methods & Materials/Patients: This is a descripti...
متن کاملThe Effectiveness of a Vocational Rehabilitation Program on the Psychological Capital in People with Spinal Cord Injury
Introduction: Vocational rehabilitation is one of the vital aspects of rehabilitation that contributes to enhancing individual, social and economic independence in daily life by increasing efficiency and restoring abilities and minimizing disabilities and achieving a capable individual. Being able to satisfy his or her job need can also enhance psychological factors. The purpose of this study w...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
دوره 13 شماره
صفحات -
تاریخ انتشار 2018