Cho Jang-Hyuk, Lee Dong-Gyu
Department of Physical Medicine, Keimyung University Dongsan Hospital, School of Medicine, Keimyung University, Daegu 42601, Korea.
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Korea.
Healthcare (Basel). 2021 Jul 8;9(7):861. doi: 10.3390/healthcare9070861.
In the general population, serial imaging is recommended over anticoagulant therapy for below-knee deep vein thrombosis (BKDVT). However, no clinical trial in Asian patients with spinal cord injury and BKDVT has been performed. Therefore, we evaluated the natural course of BKDVT in patients with acute spinal cord injury. We retrospectively analyzed inpatients with spinal cord injury with BKDVT between 2016 and 2020. All patients underwent inpatient rehabilitation treatment and duplex ultrasonographic examination of both the lower extremities at follow-up. After screening 172 patients with acute spinal cord injury for deep vein thrombosis using duplex ultrasound, 27 patients with below-the-knee deep vein thrombosis were included in this study. The mean lower-extremity motor score (median, interquartile range) was 66.0, 54.0-74.5. Sixteen patients received a non-vitamin K antagonist oral anticoagulant (NOAC) for anticoagulation. None of the patients had proximal propagation according to the follow-up duplex ultrasonography. BKDVT disappearance was not significantly different between the NOAC treatment and non-treatment groups. Asian patients with spinal cord injury have a low incidence of venous thromboembolism and favorable natural history of BKDVT. We recommend serial imaging over anticoagulant therapy for BKDVT in these patients.
在普通人群中，对于膝下深静脉血栓形成（BKDVT），推荐采用连续成像而非抗凝治疗。然而，尚未对亚洲脊髓损伤合并BKDVT患者进行临床试验。因此，我们评估了急性脊髓损伤患者BKDVT的自然病程。我们回顾性分析了2016年至2020年间脊髓损伤合并BKDVT的住院患者。所有患者均接受住院康复治疗，并在随访时对双下肢进行了双功超声检查。在使用双功超声对172例急性脊髓损伤患者进行深静脉血栓形成筛查后，本研究纳入了27例膝下深静脉血栓形成患者。下肢运动评分的平均值（中位数，四分位间距）为66.0，54.0 - 74.5。16例患者接受了非维生素K拮抗剂口服抗凝药（NOAC）进行抗凝治疗。根据随访双功超声检查，没有患者出现近端血栓扩展。NOAC治疗组和未治疗组之间BKDVT消失情况无显著差异。亚洲脊髓损伤患者静脉血栓栓塞发生率较低，BKDVT自然病程良好。对于这些患者的BKDVT，我们推荐采用连续成像而非抗凝治疗。
