Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy.

Matsumoto, S; Suda, K; Iimoto, S; Yasui, K; Komatsu, M; Ushiku, C; Takahata, M; Kobayashi, Y; Tojo, Y; Fujita, K; Minami, A

STUDY DESIGN Prospective cross-sectional study. OBJECTIVES To investigate the timing of deep vein thrombosis (DVT) onset secondary to spinal cord injury without anticoagulant therapies. SETTING Spinal Cord Injury Center in Hokkaido, Japan. METHODS Between November 2012 and June 2013, patients with spinal cord injury who were admitted to our hospital within 1 day after the injury and treated surgically within 24 h underwent a neurological examination, leg vein ultrasonography and D-dimer test 1, 3, 7, 14 and 28 days after surgery. All patients received treatment with intermittent pneumatic compression and elastic stockings, but without any anticoagulant. RESULTS DVT developed in 12 patients (11 men and 1 women), with a mean age of 62.2 years (range, 41-80 years; mean age of total sample, 63.2 years (range, 25-78 years)), all distal to the popliteal vein. DVT occurred more often with a more severe paralysis (66.3%, AIS A and B). The median (± standard error) length of time from the operation to DVT detection was 7.5±2.2 days. The mean D-dimer level upon DVT detection was 14.6±11.8 μg ml(-1), with no significant differences between those who developed DVT and those who did not at any of the time points. CONCLUSION These results suggest that DVT can develop at the very-acute stage of spinal cord injury and the incidence increases with a more severe paralysis. DVT detection was more reliable with ultrasonography, which should be used with DVT-preventive measures, beginning immediately after the injury, for the management of patients with spinal cord injury.