Clinical venous thromboembolism in spinal trauma with and without spinal cord injury: A 3-year experience of midlands centre for spinal injuries, Oswestry, UK

Abstract

Background and Aims: This study aimed to determine the incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE) among patients admitted acutely to a regional spinal injury center, following spinal trauma; to compare its occurrence between those with spinal cord injury (SCI) and those without; and to assess the effect of various factors such as age, gender, neurological impairment, and duration of prophylaxis on the incidence observed. Patients and Methods: We retrospectively reviewed the charts of 374 consecutive patients who sustained traumatic spinal injury and were admitted acutely to the Midlands Centre for Spinal Injuries, Oswestry (UK), over a 3-year period. A total of 159 patients had spinal trauma with SCI and 215 were neurologically intact. The majority of these patients were treated nonsurgically and received the same thromboprophylactic regimen started within a median of 2 days postinjury. The incidence of clinical VTE (DVT and PE) was determined and some risk factors were assessed. Ethical approval was obtained through the Audit Office Committee of the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry. Results: Among the neurologically intact group, one patient developed clinical PE (0.5%). Out of 159 patients with SCI, 23 developed clinically evident VTE (14.5%), 15 had DVT (11.9%), 4 had PE (5%), and 4 had both DVT and PE. There was no fatality. Complete SCI lesions were associated with higher incidence of VTE compared to incomplete lesions, 17.6% and 11%, respectively (P < 0.001). There were two peaks of thromboembolic episodes: the first during the first 2 weeks after injury (30% of cases) and the second was after the 8th week postinjury (38% of cases). A higher incidence of VTE was recorded in males than females (14.3% and 7.9%, respectively). Aso, the incidence of VTE is slightly higher in the age group between 40 and 60 years, but these differences were not statistically significant. Conclusions: SCI is associated with high risk of venous thromboembolism, and the risk increases with the severity of cord insult. While spinal column injury is shown to be associated with much lower risk. The risk is reduced with strict adherence to thromboprophylactic regimen which we suggest to continue for at least 12 weeks for SCI patients.