Risk factors for failure of heparin thromboprophylaxis in patients with acute traumatic spinal cord injury
| Autor: | Deborah Rubin-Asher, Ilan Asher, G Zeilig, Uri Seligsohn, Aaron Lubetsky, Aba Ratner, Ariella Zivelin |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.drug_class Premedication Thrombophilia Young Adult Predictive Value of Tests Risk Factors Internal medicine Coagulopathy Factor V Leiden Humans Trauma Nervous System Medicine Treatment Failure cardiovascular diseases Risk factor Child Spinal Cord Injuries Lupus anticoagulant Heparin business.industry Anticoagulant Thrombosis Hematology Middle Aged medicine.disease Venous thrombosis Logistic Models Case-Control Studies Anesthesia Prothrombin G20210A Female Disease Susceptibility business |
| Zdroj: | Thrombosis Research. 125:501-504 |
| ISSN: | 0049-3848 |
| DOI: | 10.1016/j.thromres.2009.09.012 |
| Popis: | Venous thromboembolism (VTE) is a well-recognized complication of Acute Traumatic Spinal Cord Injury (ATSCI). Despite prophylaxis by heparins, VTE occurs in a substantial number of ATSCI patients without an obvious explanation. In this matched case-control study we examined whether thrombophilia and other risk factors are associated with failure of thromboprophylaxis. Cases and controls receiving heparin thromboprophylaxis were selected from consecutively admitted ATSCI patients. Patients who developed a new, objectively confirmed, symptomatic VTE despite prophylaxis at hospital were matched by gender, age, level and mechanism of ATSCI with 2-3 controls without VTE. Patients were interviewed about VTE risk factors and tested for factor V Leiden (FVL), prothrombin G20210A (PT), methylenetetrahydrofolate reductase C677T homozygosity (MTHFR), lupus anticoagulant, homocysteine (Hcy) and plasma factor VIII (FVIII) levels. Twenty-two patients with new VTE episodes and 64 controls were ascertained. The total number of gene alterations for MTHFR, FVL and PT or elevated levels of Hcy or FVIII was significantly more common in patients compared to controls (82% vs. 48%, p = 0.006). Multiple logistic regression proved the PT mutation, a positive family history of thrombosis and elevated levels of either FVIII or Hcy to be predictors of thrombosis. Conclusion A positive family history of VTE, carriership of the prothrombin mutation and elevated FVIII or Hcy levels were significantly associated with failure to prevent VTE by heparin therapy following ATSCI. Testing for thrombophilia in patients with ATSCI and possibly a more intense thromboprophylactic regimen seem desirable but need to be verified by a prospective study. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect