title: Incidence and risk factors for venous thromboembolism in patients with acute spinal cord injury: A retrospective study.
abstract: BACKGROUND
  The true incidence of venous thromboembolism (VTE) in patients with acute spinal cord injury (SCI) is unclear. There are limited data on the risk factors associated with VTE in patients with an acute SCI.
  
  
  METHODS
  We performed a retrospective chart review of consecutive adult patients with acute SCI. The primary outcome was incidence of symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) within 90days. Secondary outcomes were major bleeding, all-cause mortality, and fatal PE. Step-wise Cox modeling was used to identify risk factors for VTE.
  
  
  RESULTS
  A total of 151 patients with acute SCI were included. Median age was 51 (range 17-91years) and 106 (70%) were males. Of the 151 patients, 17 (11%) had symptomatic VTE (9 PEs, 6 lower extremity DVT, 1 upper extremity DVT, and 1 with DVT and PE). In the univariable analyses, male sex and having other sites of injuries along with SCI were significant risk factors. In stepwise Cox modeling, independent risk factors were other sites of injuries (hazard ratio [HR] 6.07, 95% confidence interval [CI] 1.89-19.47, p=0.002), age (HR 1.05 per year, 95% CI 1.02-1.08, p=0.002) and the presence of leg paresis (HR 2.7, 95% CI 0.72-10.54, p=0.14), whereas hypertension appeared to reduce the risk (HR 0.18, 95% CI 0.04-0.78, p=0.02).
  
  
  CONCLUSIONS
  Symptomatic VTE is a frequent complication in patients with acute SCI. Age and presence of other sites of injuries along with SCI were independent risk factors for symptomatic VTE.
authors.affiliation: Department of Medicine, Division of Hematology and Thromboembolism, and Thrombosis and Atherosclerosis Research Institute, McMaster University, Canada. Electronic address: siavash.piran@medportal.ca.
authors.forename: Siavash
authors.initials: S
authors.lastname: Piran
authors.affiliation: Department of Medicine, Division of Hematology and Thromboembolism, and Thrombosis and Atherosclerosis Research Institute, McMaster University, Canada.
authors.forename: Sam
authors.initials: S
authors.lastname: Schulman
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications*; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000209:etiology*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: Low-molecular weight heparin; Spinal cord injury; Trauma; Venous thromboembolism