TY - JOUR
T1 - Venous thromboembolism and anticoagulation in spinal cord lesion rehabilitation inpatients
T2 - A 10-year retrospective study
AU - Bluvshtein, Vadim
AU - Catz, Amiram
AU - Mahamid, Ala
AU - Elkayam, Keren
AU - Michaeli, Dianne
AU - Front, Lilach
AU - Kfir, Adi
AU - Gelernter, Ilana
AU - Aidinoff, Elena
N1 - Publisher Copyright:
© 2023 - The authors. Published by IOS Press.
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - Deep vein thrombosis
KW - anticoagulation
KW - prophylaxis
KW - pulmonary embolism
KW - spinal cord lesions
UR - http://www.scopus.com/inward/record.url?scp=85166740884&partnerID=8YFLogxK
U2 - 10.3233/NRE-230063
DO - 10.3233/NRE-230063
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C2 - 37424485
AN - SCOPUS:85166740884
SN - 1053-8135
VL - 53
SP - 143
EP - 153
JO - NeuroRehabilitation
JF - NeuroRehabilitation
IS - 1
ER -