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Venous thromboembolism in acute spinal cord injury patients.
MedLine Citation:
PMID:  21139743     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The western literature on deep vein thrombosis (DVT) and pulmonary embolism (PE) following spinal cord injury (SCI) report an alarmingly high incidence, necessitating thromboprophylaxis. The literature on incidence from the Asian subcontinent is scanty and from India is almost nonexistent.
MATERIALS AND METHODS: Seventy hospitalized acute SCI patients presenting within five days of the injury were included in the present analysis. Forty-two cases were subjected to color Doppler studies and 28 cases had to be subjected to venography due to lack of facility at some point of time. The clinical course of the patients was closely observed during the period of hospitalization. All except 14 were managed nonoperatively. Thromboprophylaxis was not given to any patient at any stage; however, treatment was instituted in those showing the features of DVT on investigations.
RESULTS: Twelve patients died during the period of hospitalization. Deep vein thrombosis could be detected in seven patients only, three in the proximal and four in the distal segment of the lower limb and of these three died. Based on the clinical course and positive investigation report in favor of DVT, we presumed that the cause of death in these three patients was pulmonary embolism. In the other nine, in the absence of an autopsy report, the cause of deaths was considered as pulmonary infection, asphyxia, diaphragmatic paralysis, hematemesis, cervicomedullary paralysis etc. Clinical features to diagnose DVT were of little help.
CONCLUSIONS: There is a much lower incidence (10%) of DVT and PE following spinal cord injury (SCI) in India than what is reported from the western countries. Higher age group and quadriplegia were the only factors which could be correlated. Deep vein thrombosis extending proximal to the knee was significant. In the absence of autopsy and other screening tests like D-dimer test or 125I fibrogen uptake study, the true incidence of venous thromboembolism remains uncertain. Noninvasive screening of all patients for the detection of deep vein thrombosis in SCI patients is strongly recommended.
Authors:
Shyam K Saraf; Raj Jb Rana; Om P Sharma
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Indian journal of orthopaedics     Volume:  41     ISSN:  0019-5413     ISO Abbreviation:  Indian J Orthop     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2010-12-08     Completed Date:  2011-07-14     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0137736     Medline TA:  Indian J Orthop     Country:  India    
Other Details:
Languages:  eng     Pagination:  194-7     Citation Subset:  -    
Affiliation:
Department of Orthopedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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