Aito S, Pieri A, D'Andrea M, Marcelli F, Cominelli E.
Primary prevention of deep venous thrombosis and pulmonary embolism in acute
spinal cord injured patients.
Spinal Cord 2002 Jun;40(6):300-3

Unita Spinale, Careggi Hospital, Firenze, Italy.

STUDY DESIGN: Prospective clinical trial. OBJECTIVES: To evaluate the efficacy of
a specific protocol for prevention of thrombo-embolic disease occurring during
the acute stage of spinal cord lesions, based on the simultaneous use of
pharmacological plus mechanical procedures. SETTING: Regional Spinal Unit of
Florence, Italy. INTRODUCTION: Deep venous thrombosis (DVT) is a dangerous
pathology whose first clinical sign can be represented by unexpected pulmonary
embolism (PE). Its incidence in acute spinal cord injured (SCI) patients is
reported to range between 9% and 90%. Its prevention represents one of the major
challenges for the clinicians involved in the care of such patients. METHOD: Two
hundred and seventy-five SCI patients consecutively admitted to our Centre were
investigated by colour doppler ultrasonography of lower limbs and pelvis on
admission, after 30-45 days and whenever clinically requested. Subcutaneous
Nadroparine, a low molecular weight heparin (LMWH), plus early mobilisation,
permanently dressed gradient elastic stockings (PGES), and external sequential
pneumatic compression (ESPC) of the lower limbs, applied during the first 30 days
after injury, were given to all of them. Colour doppler ultrasonography (CDUS)
complete investigations of the lower limbs and pelvis were performed on
admission, after 30-45 days and whenever clinically requested. The patients were
divided into two groups according to their time interval from injury to the
admission to our Centre. RESULTS: The incidence of detected DVT was 2% in those
patients (99) admitted early to our centre (within 72 h from the trauma), who
immediately received our prophylactic protocol. No PE was reported. The other
group of patients (176), all admitted between 8 and 28 days (mean 12 days)
developed DVT in 26% of cases. None of these patients received ESPC before being
admitted to our Centre. No patient had been admitted between 3 and 8 days
interval time post injury. CONCLUSION: Early application of pharmacological plus
mechanical treatment for DVT prevention produces a marked reduction in such
complications. It also reduces the risks of morbidity and mortality in our
patients, and, not least, reduces the hospitalization costs during the early
period of rehabilitation.