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. 2023;53(1):143-153.
doi: 10.3233/NRE-230063.

Venous thromboembolism and anticoagulation in spinal cord lesion rehabilitation inpatients: A 10-year retrospective study

Vadim Bluvshtein  1   2 , Amiram Catz  1   2 , Ala Mahamid  1 , Keren Elkayam  1 , Dianne Michaeli  1 , Lilach Front  1 , Adi Kfir  1 , Ilana Gelernter  3 , Elena Aidinoff  2   4
Affiliations

Venous thromboembolism and anticoagulation in spinal cord lesion rehabilitation inpatients: A 10-year retrospective study

Vadim Bluvshtein et al. NeuroRehabilitation. 2023.

Abstract

Background: Venous thromboembolism (VTE) is a concern following the onset of spinal cord lesions (SCL).

Objectives: To assess the current efficacy and risks of anticoagulation after SCL and consider changes in thromboprophylaxis.

Methods: This retrospective cohort study included individuals admitted to inpatient rehabilitation within 3 months of SCL onset. Main outcome measures were the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, thrombocytopenia, or death, which occurred within 1 year of the SCL onset.

Results: VTE occurred in 37 of the 685 patients included in the study (5.4%, 95% CI 3.7-7.1%, 2.8% PE), and in 16 of 526 patients who received prophylactic anticoagulation at rehabilitation (3%, 95% CI 1.6-4.5%, 1.1% PE, with at least 1 fatality). Of these 526, 1.3% developed clinically significant bleeding and 0.8% thrombocytopenia. Prophylactic anticoagulation, most commonly 40 mg/day, continued until a median period of 6.4 weeks after SCL onset (25% -75% percentiles 5.8-9.7), but in 29.7%, VTE occurred more than 3 months after SCL onset.

Conclusion: The VTE prophylaxis used for the present cohort contributed to a considerable but limited reduction of VTE incidence. The authors recommend conducting a prospective study to assess the efficacy and safety of an updated preventive anticoagulation regimen.

Keywords: Deep vein thrombosis; anticoagulation; prophylaxis; pulmonary embolism; spinal cord lesions.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Time from SCL onset to VTE diagnosis (months). Dark gray represents individuals with risk factors for VTE other than SCL. Light gray represents individuals with no documented risk factors.
Fig. 2
Fig. 2
Duration (weeks) of prophylactic therapy during impatient rehabilitation. Light gray bars represent patient with AIS grades A–C; dark gray bars represent patients with AIS grade D. The figure refers to patients admitted without a VTE diagnosis.
See this image and copyright information in PMC

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