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Evolving risk for thromboembolism in spinal cord injury (SPIRATE Study)
David Green1, Susan Sullivan, Janet Simpson
1Department of Medicine, Feinberg School of Medicine, Northwestern University, the Rehabilitation Institute of Chicago, Chicago, Illinois 60611, USA.
Summary
The frequency of venous thromboembolism (VTE) in spinal cord injury patients significantly decreased from 21% to 7.9%. This reduction coincided with a shift in anticoagulant prophylaxis from unfractionated heparin to low molecular weight heparin.
Area of Science:
- Neurology
- Vascular Surgery
- Pharmacology
Background:
- Venous thromboembolism (VTE) is a serious complication in patients with spinal cord injury (SCI).
- Previous studies indicated a high frequency of VTE in SCI patients.
- Understanding trends in VTE and its prevention is crucial for patient outcomes.
Purpose of the Study:
- To compare the incidence of VTE in SCI patients between two distinct time periods: 1992-1995 and 1999-2003.
- To identify factors associated with changes in VTE frequency over time.
Main Methods:
- Retrospective chart review of SCI patients admitted for rehabilitation.
- Inclusion criteria focused on objective VTE testing and exclusion of patients with vena cava filters or prior VTE.
- Univariate optimal discriminant analysis was used to compare the current cohort with a historical cohort.
Main Results:
- The VTE rate decreased significantly from 21% in 1992-1995 to 7.9% in 1999-2003 (P<0.01).
- A notable shift in anticoagulant use was observed: unfractionated heparin decreased from 56.8% to 15.8%, while low molecular weight heparin increased from 59.7% to 81.6%.
Conclusions:
- The adoption of low molecular weight heparin (LMWH) as a primary prophylactic agent for VTE in SCI patients is associated with a significant reduction in VTE incidence.
- This transition in anticoagulant strategy represents a key advancement in managing SCI-related complications.