eMedicine Specialties > Physical Medicine and Rehabilitation > Spinal Cord Injury

Prevention of Thromboembolism in Spinal Cord Injury: Follow-up

Author: Dana McKinney, MD, Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center
Coauthor(s): Susan V Garstang, MD, Assistant Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey; Attending Medical Staff, Director of Spinal Cord Injury Program, Department of Physical Medicine and Rehabilitation, University Hospital
Contributor Information and Disclosures

Updated: Jan 13, 2009

Follow-up

Further Inpatient Care

  • The recommendation is that deep vein thrombosis (DVT) prophylaxis be continued for a minimum of 8 weeks following injury in patients with uncomplicated, complete motor spinal cord injury (SCI) and for 12 weeks in patients with complete motor injury and other risk factors. If the patient is discharged from the hospital prior to the recommended time, then DVT prophylaxis can be continued on an outpatient basis, provided that adequate home care and close medical follow-up can be arranged. Patients with SCI who have recurrences of thromboembolic disease also may require prolonged therapy.

Complications

  • Failure of deep vein thrombosis (DVT) prophylaxis
    • Pulmonary embolism (PE) is the most serious and fatal complication of DVT. Acute PE may occur despite adequate thromboprophylaxis.
    • Recurrence of DVT is a complication in patients with SCI.
    • Postphlebitic syndrome is a late complication of DVT and is associated with venous insufficiency.
  • Hemorrhagic complications from anticoagulation

Prognosis

  • The prompt and accurate diagnosis of deep vein thrombosis (DVT) is vital to the initiation of proper treatment; such treatment can prevent more serious complications, such as clot progression and/or pulmonary embolism (PE).
  • For patients with acute spinal cord injury, the risk of death due to PE is 210 times greater than that for a similar, healthy population. According to the CPG, this risk decreases to 19.1 times the normal risk during years 2-5; it further decreases, to 8.9 times the normal risk, in patients who survive more than 5 years.12,13

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to provide adequate deep vein thrombosis (DVT) prophylaxis in acute spinal cord injury (SCI) patients, based on current literature
  • Failure to consider the diagnosis of DVT/pulmonary embolism in symptomatic SCI patients and to perform appropriate studies in a timely manner
  • Failure of health care providers to understand the rate of incidence of and the risk factors for thromboembolism development in SCI patients, because patients frequently are asymptomatic
  • Failure to consider the reinstitution of prophylactic measures in chronic SCI patients who have acute medical illnesses or surgical procedures, if they are immobilized with bedrest for prolonged periods of time
 


More on Prevention of Thromboembolism in Spinal Cord Injury

Overview: Prevention of Thromboembolism in Spinal Cord Injury
Differential Diagnoses & Workup: Prevention of Thromboembolism in Spinal Cord Injury
Treatment & Medication: Prevention of Thromboembolism in Spinal Cord Injury
Follow-up: Prevention of Thromboembolism in Spinal Cord Injury
References
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References

  1. Yu HT, Dylan ML, Lin J, et al. Hospitals' compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm. Jan 1 2007;64(1):69-76. [Medline].

  2. Powell M, Kirshblum S, O'Connor KC. Duplex ultrasound screening for deep vein thrombosis in spinal cord injured patients at rehabilitation admission. Arch Phys Med Rehabil. Sep 1999;80(9):1044-6. [Medline].

  3. 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. Dec 2005;86(12):2240-7. [Medline].

  4. Akers SM, Bartter T, Pratter MR. Impedance plethysmography. It's the clinical outcome that counts. Chest. Nov 1994;106(5):1317-8. [Medline]. [Full Text].

  5. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. Jun 2008;133(6 Suppl):381S-453S. [Medline].

  6. Green D. Prophylaxis of thromboembolism in spinal cord-injured patients. Chest. Dec 1992;102(6 Suppl):649S-651S. [Medline]. [Full Text].

  7. Clagett GP, Anderson FA, Geerts W, et al. Prevention of venous thromboembolism. Chest. Nov 1998;114(5 Suppl):531S-560S. [Medline]. [Full Text].

  8. Clagett GP, Anderson FA, Heit J, et al. Prevention of venous thromboembolism. Chest. Oct 1995;108(4 Suppl):312S-334S. [Medline]. [Full Text].

  9. Geerts WH, Jay RM, Code KI, et al. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med. Sep 5 1996;335(10):701-7. [Medline]. [Full Text].

  10. Green D, Lee MY, Lim AC, et al. Prevention of thromboembolism after spinal cord injury using low-molecular-weight heparin. Ann Intern Med. Oct 15 1990;113(8):571-4. [Medline].

  11. Shackford SR, Cook A, Rogers FB, et al. The increasing use of vena cava filters in adult trauma victims: data from the American College of Surgeons National Trauma Data Bank. J Trauma. Oct 2007;63(4):764-9. [Medline].

  12. Burns SP, Nelson AL, Bosshart HT, et al. Implementation of clinical practice guidelines for prevention of thromboembolism in spinal cord injury. J Spinal Cord Med. 2005;28(1):33-42. [Medline].

  13. Consortium for Spinal Cord Medicine Clinical Practice Guidelines. Prevention of Thromboembolism in Spinal Cord Injury. 2nd ed. Washington, DC: Paralyzed Veterans of America; 1999.

  14. Hebbeler SL, Marciniak CM, Crandall S, et al. Daily vs twice daily enoxaparin in the prevention of venous thromboembolic disorders during rehabilitation following acute spinal cord injury. J Spinal Cord Med. 2004;27(3):236-40. [Medline].

  15. Slavik RS, Chan E, Gorman SK, et al. Dalteparin versus enoxaparin for venous thromboembolism prophylaxis in acute spinal cord injury and major orthopedic trauma patients: 'DETECT' trial. J Trauma. May 2007;62(5):1075-81; discussion 1081. [Medline].

  16. Worley S, Short C, Pike J, et al. Dalteparin vs low-dose unfractionated heparin for prophylaxis against clinically evident venous thromboembolism in acute traumatic spinal cord injury: a retrospective cohort study. J Spinal Cord Med. 2008;31(4):379-87. [Medline].

  17. Anand SS, Wells PS, Hunt D, et al. Does this patient have deep vein thrombosis?. JAMA. Apr 8 1998;279(14):1094-9. [Medline].

  18. Green D, Rossi EC, Yao JS, et al. Deep vein thrombosis in spinal cord injury: effect of prophylaxis with calf compression, aspirin, and dipyridamole. Paraplegia. Aug 1982;20(4):227-34. [Medline].

  19. Green D, Sullivan S, Simpson J, et al. Evolving risk for thromboembolism in spinal cord injury (SPIRATE Study). Am J Phys Med Rehabil. Jun 2005;84(6):420-2. [Medline].

  20. Merli GJ, Crabbe S, Doyle L, et al. Mechanical plus pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury. Paraplegia. Aug 1992;30(8):558-62. [Medline].

  21. 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. Nov 1993;74(11):1199-205. [Medline].

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Further Reading

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Keywords

deep venous thrombosis, embolism, DVT, pulmonary embolism, spinal cord injury, clot, blood clot, blood clots, paralysis, spinal cord, spinal, platelet, platelets, thromboembolism, vein thrombosis, deep vein thrombosis, venous thrombosis, anticoagulation, paraplegia, thromboembolic disease, vein thrombosis treatment, venous thrombosis treatment

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Contributor Information and Disclosures

Author

Dana McKinney, MD, Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center
Dana McKinney, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Paraplegia Society, and National Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Susan V Garstang, MD, Assistant Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey; Attending Medical Staff, Director of Spinal Cord Injury Program, Department of Physical Medicine and Rehabilitation, University Hospital
Susan V Garstang, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Medical Editor

Milton J Klein, DO, MBA, Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital, Allegheny General Hospital, and Ohio Valley General Hospital.
Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Kat Kolaski, MD, Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine
Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching; Genzyme Corporation Grant/research funds investigator; Biogen Idec Grant/research funds investigator; Genentech, Inc Grant/research funds investigator; Eli Lilly & Company Grant/research funds Novaritis; Novaritis  Novaritis; MSDx LLC Grant/research funds investigator; BioMS Technology Corp Grant/research funds investigator; Avanir Pharmaceuticals Grant/research funds investigator

 
 
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