Furlan Julio C, Fehlings Michael G
Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 2007 Aug 1;32(17):1908-16. doi: 10.1097/BRS.0b013e31811ec26a.
Systematic review.
To examine the evidence to support practice guidelines for screening for DVT in asymptomatic adults with acute traumatic spinal cord injury (SCI) who undergo pharmacologic thromboprophylaxis.
Despite the fact that pharmacologic thromboprophylaxis has been widely used since the 1980s, deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) still account for approximately 10% of deaths during the first year following SCI.
MEDLINE and EMBASE were searched from the earliest achievable date to December 2005. We only included clinical studies that used a screening test for DVT and the gold standard diagnostic tests for DVT (i.e., lower limb venography) and for PE (i.e., lung arteriogram) in adults with traumatic SCI who underwent drug thromboprophylaxis during the acute stage after SCI.
The search yielded 188 articles, of which 9 articles fulfilled the criteria to be included in our review. Screening for DVT was performed in 3 randomized clinical trials and 6 case series. The protocol of these studies included the use of D-Dimer (1 of 9), I-labeled fibrinogen (2 of 9), ultrasound (1 of 9), impedance plethysmography (1 of 9), impedance plethysmography and Doppler in combination (1 of 9), Duplex (1 of 9) or venography (2 of 9) as screening test for DVT. Based on the pooled data of these studies, asymptomatic DVT was detected in 16.9% of SCI population. Only 4 studies reported the occurrence of PE in 4.4% of cases.
There is insufficient evidence to support (or refute) a recommendation for routine screening for DVT in adults with acute traumatic SCI under thromboprophylaxis. However, there is level II-2 evidence that screening could detect asymptomatic DVT in 22.7% of those individuals. Although additional investigation is needed, we hypothesize that weekly screening for DVT during the first 13 weeks post-SCI could detect most of the asymptomatic DVT events in this patient population. D-Dimer, ultrasound, and MR venography could be considered as potentially useful screening tests for DVT in the SCI population in future research studies.
系统评价。
审查支持对接受药物预防血栓形成的无症状急性创伤性脊髓损伤（SCI）成人进行深静脉血栓形成（DVT）筛查的实践指南的证据。
尽管自20世纪80年代以来药物预防血栓形成已被广泛使用，但深静脉血栓形成（DVT）及随后的肺栓塞（PE）在脊髓损伤后的第一年死亡中仍占约10%。
检索MEDLINE和EMBASE数据库，时间跨度从最早可检索日期至2005年12月。我们仅纳入了对接受药物预防血栓形成的创伤性脊髓损伤成人进行DVT筛查试验以及DVT（即下肢静脉造影）和PE（即肺血管造影）的金标准诊断试验的临床研究。
检索到188篇文章，其中9篇符合纳入本综述的标准。在3项随机临床试验和6个病例系列中进行了DVT筛查。这些研究的方案包括使用D - 二聚体（9项中的1项）、I标记纤维蛋白原（9项中的2项）、超声（9项中的1项）、阻抗体积描记法（9项中的1项）、阻抗体积描记法和多普勒联合使用（9项中的1项）、双功超声（9项中的1项）或静脉造影（9项中的2项）作为DVT的筛查试验。基于这些研究的汇总数据，在16.9%的脊髓损伤人群中检测到无症状DVT。只有4项研究报告了4.4%的病例发生PE。
没有足够的证据支持（或反驳）对接受血栓预防的急性创伤性脊髓损伤成人进行常规DVT筛查的建议。然而，有II - 2级证据表明筛查可以在22.7%的此类个体中检测到无症状DVT。尽管需要进一步研究，但我们推测在脊髓损伤后的前13周每周进行DVT筛查可以检测到该患者群体中的大多数无症状DVT事件。在未来的研究中，D - 二聚体、超声和磁共振静脉造影可被视为脊髓损伤人群中DVT潜在有用的筛查试验。
