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

• Published in: NeuroRehabilitation (Reading, Mass.) Vol. 53; no. 1; pp. 143 - 153
• Main Authors: Bluvshtein, Vadim, Catz, Amiram, Mahamid, Ala, Elkayam, Keren, Michaeli, Dianne, Front, Lilach, Kfir, Adi, Gelernter, Ilana, Aidinoff, Elena
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 04.08.2023; IOS Press BV; IOS Press
• Subjects: Anticoagulants - therapeutic use; Bleeding; Embolism; Humans; Inpatients; Prophylaxis; Prospective Studies; Pulmonary Embolism - drug therapy; Pulmonary Embolism - etiology; Pulmonary Embolism - prevention & control; Pulmonary embolisms; Rehabilitation; Retrospective Studies; Spinal Cord; Thrombocytopenia; Thrombocytopenia - drug therapy; Thrombocytopenia - etiology; Thromboembolism; Thrombosis; Venous Thromboembolism - epidemiology; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control; Deep vein thrombosis; spinal cord lesions; pulmonary embolism; prophylaxis; anticoagulation
• ISSN: 1053-8135; 1878-6448
• DOI: 10.3233/NRE-230063

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.