Clinical Study of Thromboembolism in Patients with Orthopedic Spinal Traumas View PDF

^*Rafid Abdulameer Yaseen Al-Adhab
Medicine, Al-Sadr Teaching Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq
Alaa Abdulhasan Jumaah
Medicine, Al-Fayhaa Teaching Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq
Ihsan Falih Noori
Medicine, Al-Zubair General Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq

^*Corresponding Author:

Rafid Abdulameer Yaseen Al-Adhab
Medicine, Al-Sadr Teaching Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq

Published on: 2025-05-01

Abstract

Venous thromboembolism (VTE) remains a significant risk following spinal injuries, though its true incidence varies. In this retrospective study of 374 consecutive patients admitted to a comprehensive spinal care center, we assessed the incidence of clinical VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), in both neurologically intact and spinal cord injury (SCI) patients. The majority of patients received non-surgical treatment and thromboprophylaxis initiated within a median 2 day post-injury. Among the neurologically intact groups, only one patient developed clinical PE (0.5%). However, 23 patients (14.5%) developed clinically evident VTE, with 15 (11.9%) diagnosed with DVT, 4 (5%) with PE, and 4 with both. Complete SCI lesions were associated with a significantly higher incidence of VTE (17.6%) compared to incomplete lesions (11%; p < 0.001). Two distinct peaks in thromboembolic events were observed: one in the first two weeks post-injury (30% of cases), and another after the 8th week following the discontinuation of thromboprophylaxis (38% of cases). These findings highlight the increased risk of VTE associated with more severe spinal cord injuries. While spinal column injuries in neurologically intact patients were associated with a lower risk, strict adherence to thromboprophylaxis protocols effectively reduced the incidence of VTE. We recommend that thromboprophylaxis continue for at least 12 weeks postinjury in SCI patients to mitigate the risk of VTE, especially in those with complete spinal cord lesions or other high-risk factors.

Keywords

Spinal injury, Spinal cord injury, Pulmonary embolism, Deep vein thrombosis, Venous thromboembolism, Thromboprophylaxis

Introduction

VTE is a well-documented and potentially fatal complication in patients with SCI. PE has been reported as the cause of death in approximately 37% of SCI patients who died within three months of injury in the absence of thromboprophylaxis [1, 2]. The introduction of prophylactic measures has significantly reduced mortality rates. Mackiewicz-Milewska et al. [3], Horiuchi and Fukuoka [4] reported a PE-related mortality rate of 4% in patients receiving thromboprophylaxis. Similarly, Laginha et al. [5] reported that PE was responsible for 9.7% of deaths within the first-year post-injury among 496 SCI patients. Singh et al. [6] observed a 14% incidence of clinically evident DVT in 909 patients with acute SCI, with no significant difference between surgically and non-surgically managed patients (13% vs 15%, respectively). The incidence of PE was 5% in both groups [7].

At our comprehensive spinal injury care center, we implement a standardized thromboprophylactic regimen combining pharmacological agents-such as low molecular weight heparin (LMWH) or warfarin-with mechanical methods for all patients, irrespective of neurological status. In this study, we evaluate the efficacy of this regimen and examine the variation in VTE incidence based on age, sex, injury level, presence or absence of neurological deficit, and its severity.