Венозные тромбоэмболические осложнения при травме спинного мозга на уровне шейного отдела позвоночника

Summary. Background. Injury to the cervical spinal cord (SC) leads to the loss of motor and sensory functions and is associated with a high risk of venous thromboembolic complications (VTC). Objectives: to determine the nature, frequency, and predictors of VTC in patients with cervical SC injury using standard thromboprophylaxis regimens. Patients/Methods. The study included 111 patients with SC injury who were treated at Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics in 2010– 2019. All patients were admitted during the acute phase of trauma, 89% of them were operated. Thromboprophylaxis was used for all patients; they were divided into 2 groups: Group I included 30 patients who received Nadroparin calcium; Group II included 81 patients who received Enoxaparin sodium. The primary endpoint of the study was the diagnosed lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE). Possible predictors of VTC were analyzed. Results. Lower extremity DVT developed in 11.7% of male patients: in 6 patients in Group I, and in 7 patients in Group II (p=0.109). According to classification of American Spinal Injury Association (ASIA) in 62% of cases DVT developed in patients with ASIA A severity of SC injury, and in 99.1% of cases in operated patients. In 87% of cases, DVT was asymptomatic, and hemostasis parameters corresponded to normocoagulation. In 77% of patients blood clots are localized in sural veins of lower limbs. Total PE incidence was 5.4% without significant differences between groups (p=0.661). Age increment increases the chances of DVT developing, and thrombosis development within three days from the moment of injury increases the risk of PE by 25.33 [0.87; 764.12] times (p = 0.035). Conclusions. The early identifica- tion of thrombosis risk and thromboprophylaxis optimization required the introduction of integral laboratory tests of hemostasis in clinical practice. References: Hasler R.M., Exadaktylos A.K., Bouamra O. et al. Epidemiology and predictors of cervical spine injury in adult major trauma patients: European cohort study. Eur Spine J. 2011;20(12):2174– 80. DOI: 10.1007/s00586–011–1866–7. 
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