DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20192692

A cross sectional study to measure prevalence of DVT in subacute and chronic spinal cord injury patients without any chemical prophylaxis

Ashish Pande, Biraj Gogoi, Sandeep Dubey, Anil Kumar Mishra

Abstract


Background: Prevalence of DVT in patients with sub-acute and chronic SCI has only been reported in a limited number of studies. Knowing the incidence of thromboembolic events in the sub-acute and chronic rehabilitation phase is important to estimate disease risk and facilitate evidence based prevention. We sought to determine the prevalence of DVT in patients of subacute and chronic phases post spinal cord injury without any chemical prophylaxis.

Methods: Between June 2016 and April 2018, all cases of sub-acute and chronic spinal cord injury, undergoing rehabilitation at our centre were studied. Patients with pre-existing coagulopathy/hypercoagulable state/ bleeding diathesis or on medications for these conditions, tobacco smokers, chronic alcoholics and obese individuals were excluded from the study. All patients enrolled in the study were given mechanical DVT prophylaxis and followed institutional rehabilitation protocol. They were evaluated at 3 months, 6 months and 9 months by clinical examination and CDFI for any evidence of DVT.

Results: Out of 60 patients studied, 04 patients developed DVT (3 in ASIA grade A and 1 in ASIA grade B patient). 75% (3 cases) of the cases were detected in the first 3 months and only one case was detected between 3-6 moths post Spinal cord injury. The prevalence of DVT in our study, in subacute and chronic cases of spinal cord injury was 6.67%.

Conclusions: Our study is in concurrence with the existing literature about the low prevalence of DVT in Southeast Asian population which doesn’t warrant DVT chemoprophylaxis in subacute and chronic SCI cases.


Keywords


Spinal cord injury, Sub-acute, Chronic, DVT, Chemoprophylaxis, CDFI, SCI

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References


Abraham P, Ternisien C, Hubert L,Pidhorz L, Saumet JL: Does venousmicroemboli detection add to the interpretation of D-dimer valuesfollowingorthopaedic surgery Ultrasound Med Biol 1999;25(4):637-640.

Schmidt B, Michler R, Klein M,Faulmann G, Weber C, Schellong S:Ultrasound screening for distal veinthrombosis is not beneficial after major orthopedic surgery: A randomizedcontrolled trial. ThrombHaemost2003;90(5):949-954.

Heijboer H, Büller HR, Lensing AWA, Turpie AGG, Colly LP, ten Cate JW. A comparison of real-time ultrasonography with impedance plethysmography for the diagnosis of deep-vein thrombosis in symptomatic outpatients. N Engl J Med 1993;329:1365-9.

Lensing AWA, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G, et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 1989;320:342-5.

Appelman PT, de Jong TE, Lampmann LE. Deep venous thrombosis of the leg: US findings. Radiology 1987;163:743-8.

Magdalena Mackiewicz-Milewska, Stanisław Jung, Andrzej C. Kroszczyński,Hanna Mackiewicz-Nartowicz, Zbigniew Serafin, Małgorzata Cisowska-Adamiak,Jerzy Pyskir, Iwona Szymkuć-Bukowska, Wojciech Hagner, and Danuta Rość Deep venous thrombosis in patients with chronic spinal cord injury J Spinal Cord Med. 2016 Jul; 39(4): 400–404.

Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed. Consortium for Spinal Cord MedicineTop Spinal Cord Inj Rehabil. 2016 Summer; 22(3): 209–240. doi: 10.1310/sci2203-209.

Gordon H. Guyatt, Elie A. Akl, Mark Crowther, David D. Gutterman, Holger J. Schuünemann and for the American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines Chest 2012;141;7S-47S DOI 10.1378/chest.1412S3.

Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest.Feb 2012;141(2 Suppl):e351S-418S.

Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest.Feb 2012;141(2 Suppl):e351S-418S.

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 Nov. 74(11):1199-205.

Todd JW, Frisbie JH, Rossier AB, Adams DF, Als AV, Armenia RJ, Sasahara AA, Tow DE. Deep venous thrombosis in acute spinal cord injury: a comparison of 125I fibrinogen leg scanning, impedance plethysmography and venography. Paraplegia. 1976;14:50–57.

Perkash A, Prakash V, Perkash I. Experience with the management of thromboembolism in patients with spinal cord injury: part I. incidence, diagnosis and role of some risk factors. Paraplegia. 1978;16:322–331.

Watson N. Anti-coagulant therapy in the prevention of venous thrombosis and pulmonary embolism in the spinal cord injury. Paraplegia. 1978;16:265–269.

N K Agarwal. N Mathur. Physical therapy versus heparin for prevention of deep venous thrombosisSpinal Cord 47(10):769-72 · April 2009.