Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with spinal cord injury: a nationwide cohort prospective study.
BACKGROUND
We investigated the effect of spinal cord injury (SCI) on the development of deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) by conducting a nationwide longitudinal cohort study.


METHODS
We studied the entire hospitalized population in Taiwan for the 1998-2008 period, with a follow-up period extending to the end of 2010. We identified SCI patients using the Taiwan National Health Insurance Research Database (NHIRD), and selected a cohort that was 1:4 frequency-matched by age (5-y span), sex, and index year from the general population. We analyzed the risks of DVT and PE using Cox proportional-hazards regression models, which included the demographic variables of sex, age, and comorbidities.


RESULTS
A total of 47,916 SCI patients (62.7% men, mean age of 50.0 y) and 191,664 controls were followed for 308,266 and 1,341,169 person-years, respectively. The adjusted hazard ratio (HR) of DVT and PE development was 2.46-fold and 1.57-fold among the SCI patients, respectively. The highest risk of DVT and PE developed within 3months after an SCI occurred (HR: 16.9 and 3.64, respectively). The adjusted HR of DVT and PE rose markedly with increasing age. The adjusted HR of DVT was highest among C-spine SCI patients, and the adjusted HR of PE was highest among T-spine SCI patients.


CONCLUSIONS
This nationwide prospective cohort study demonstrated that the risk of DVT and PE increased significantly in SCI patients compared with that of the general population. The highest risk of DVT and PE developed within 3months after an SCI occurred.
Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Executive Yuan, Taichung, Taiwan; Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan.
Wei-Sheng
WS
Chung
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
Cheng-Li
CL
Lin
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Department of Medical Research, Taichung Veterans General Hospital,Taichung, Taiwan.
Shih-Ni
SN
Chang
Department of Neurosurgery, Taichung Hospital, Ministry of Health and Welfare, Executive Yuan, Taichung, Taiwan.
Hui-Ann
HA
Chung
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Fung-Chang
FC
Sung
Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. Electronic address: d10040@mail.cmuh.org.tw.
Chia-Hung
CH
Kao
D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology; D020246:Venous Thrombosis / Q000097:blood / Q000453:epidemiology* / Q000209:etiology
deep vein thrombosis (DVT); pulmonary thromboembolism (PE); spinal cord injury (SCI)