Study on the preventive effect of pneumatic compression therapy on deep venous thrombosis of lower limbs in patients with spinal cord injury_West China Medical Journal

Authors：

ZHANG Jinlong ^1,2 , NI Chaomin ¹ , HUANG Yan ¹ , WU Ming ¹ , TAO Ye ¹ , ZHOU Jing ¹ ,  WANG Cheng ¹

1. Rehabilitation Department, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, Anhui 230001, P. R. China;
2. Rehabilitation Department, Hefei BOE Hospital, BOE Technology Group Co., Ltd, Hefei, Anhui 230012, P. R. China;

Corresponding author：

WANG Cheng, Email: wcahslyy@163.com

Keywords：

Spinal cord injury; Deep vein thrombosis; Pneumatic compression therapy

DOI：

10.7507/1002-0179.202012347

Video：

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Objective To understand the preventive effect of pneumatic compression therapy on deep vein thrombosis (DVT) in lower limbs of patients with spinal cord injury. Methods Patients with spinal cord injury who transferred from Orthopedics Department to Rehabilitation Department undergoing rehabilitation in the First Affiliated Hospital of University of Science and Technology of China and discharged from April 2017 to December 2020 were retrospectively included. According to the contents of the medical order of the case data, the patients were divided into treatment group and control group. The intervention method of the treatment group was pneumatic compression therapy and conventional rehabilitation treatment, and the control group was conventional rehabilitation treatment. Multivariate logistic regression was used for statistical analysis to explore the association of pneumatic compression therapy and the risk of DVT in patients with spinal cord injury. Results Finally, 153 patients were enrolled, including 71 cases in the treatment group and 82 cases in the control group. After rehabilitation therapy, DVT occurred in 10 cases (14.1%) in the treatment group and 21 cases (25.6%) in the control group. There was no significant difference in incidence of DVT between the two groups (χ²=3.129, P=0.077). After six months of follow-up, DVT occurred in 11 cases (15.5%) in the treatment group and 12 cases (14.6%) in the control group. There was no significant difference in incidence of DVT between the two groups (χ²=0.022, P=0.822). D-dimer [odds ratio (OR) =1.104, 95% confidence interval (CI) (1.036, 1.175), P=0.002] and age [OR=1.081, 95%CI (1.040, 1.124), P<0.001] were independent risk factors for the risk of DVT after treatment. Pneumatic compression therapy was a protective factor for the risk of DVT [OR=0.210, 95%CI (0.075, 0.591), P=0.003]. Age [OR=1.057, 95%CI (1.008, 1.108), P=0.023] was an independent risk factor for the risk of DVT after six months. The effect of pneumatic compression therapy was not statistically significant (P=0.393). Conclusions After spinal cord injury, it is necessary to strengthen the management of high serum D-dimer state, especially the risk of DVT in elderly patients. Pneumatic compression therapy could be used as a treatment measure to reduce risk of DVT in patients with spinal cord injury during hospitalization, however, the preventive effect after half a year needs to be further studied.

Citation： ZHANG Jinlong, NI Chaomin, HUANG Yan, WU Ming, TAO Ye, ZHOU Jing, WANG Cheng. Study on the preventive effect of pneumatic compression therapy on deep venous thrombosis of lower limbs in patients with spinal cord injury. West China Medical Journal, 2021, 36(11): 1550-1555. doi: 10.7507/1002-0179.202012347 Copy

1.	Hon B, Botticello A, Kirshblum S. Duplex ultrasound surveillance for deep vein thrombosis after acute traumatic spinal cord injury at rehabilitation admission. J Spinal Cord Med, 2020, 43(3): 298-305.
2.	唐进, 杨涛, 熊小江, 等. 空气波压力治疗预防全膝关节置换后下肢深静脉血栓. 中国组织工程研究, 2013, 17(52): 8981-8986.
3.	Clarke M, Broderick C, Hopewell S, et al. Compression stockings for preventing deep vein thrombosis in airline passengers. Cochrane Database Syst Rev, 2016, 14(9): 1-51.
4.	Green D, Rossi EC, Yao JS, et al. Deep vein thrombosis in spinal cord injury: effect of prophylaxis with calf compression, aspirin, and dipyridamole. Paraplegia, 1982, 20(4): 227-234.
5.	Amin E, Bistervels I, Meijer K, et al. Reduced incidence of vein occlusion and postthrombotic syndrome after immediate compression for deep vein thrombosis. Blood, 2018, 132(21): 2298-2304.
6.	Turrian U, Malloizel-Delaunay J, Bura-Rivière A. Management of upper extremity deep vein thrombosis in Occitanie: practice assessment. J Med Vasc, 2020, 45(5): 288-293.
7.	Chung S, Lee S, Kim E, et al. Incidence of deep vein thrombosis after spinal cord injury: a prospective study in 37 consecutive patients with traumatic or nontraumatic spinal cord injury treated by mechanical prophylaxis. J Trauma, 2011, 71(4): 867-871.
8.	康海琼, 周红俊, 刘根林, 等. 脊髓损伤神经学分类国际标准检查表 2019 版最新修订及解读. 中国康复理论与实践, 2019, 25(8): 983-985.
9.	李建军, 周红俊, 孙迎春, 等. 脊髓损伤神经学分类国际标准(第 6 版, 2006). 中国康复理论与实践, 2008, 14(7): 693-698.
10.	Su YS, Hill J, Gelman A, et al. Multiple Imputation with diagnostics (mi) in R: opening windows into the black box. J Stat Softw, 2011, 45(2): 1-31.
11.	Portet S. A primer on model selection using the Akaike Information Criterion. Infect Dis Model, 2020, 5: 111-128.
12.	Shaw E, Saulino M. Management strategies for spinal cord injury pain updated for the twenty-first century. Phys Med Rehabil Clin N Am, 2020, 31(3): 369-378.
13.	Badhiwala JH, Wilson JR, Witiw CD, et al. The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. Lancet Neurol, 2021, 20(2): 117-126.
14.	Leibinger M, Zeitler C, Gobrecht P, et al. Transneuronal delivery of hyper-interleukin-6 enables functional recovery after severe spinal cord injury in mice. Nat Commun, 2021, 12(1): 391.
15.	Delparte JJ, Flett HM, Scovil CY, et al. Development of the spinal cord injury pressure sore onset risk screening (SCI-PreSORS) instrument: a pressure injury risk decision tree for spinal cord injury rehabilitation. Spinal cord, 2021, 59(2): 123-131.
16.	Shams R, Drasites KP, Zaman V, et al. The pathophysiology of osteoporosis after spinal cord injury. Int J Mol Sci, 2021, 22(6): 3057.
17.	Smuder AJ, Turner SM, Schuster CM, et al. Hyperbaric oxygen treatment following mid-cervical spinal cord injury preserves diaphragm muscle function. Int J Mol Sci, 2020, 21(19): 7219.
18.	Ge JS, Chang TT, Zhang ZJ. Reliability of myotonometric measurement of stiffness in patients with spinal cord injury. Med Sci Monit, 2020, 26: e924811.
19.	Chang SC, Zeng S, Tsai SJ. Outcome of different approaches to reduce urinary tract infection in patients with spinal cord lesions: a systematic review. Am J Phys Med Rehabil, 2020, 99(11): 1056-1066.
20.	Yong T, Lili Y, Wen Y, et al. Pulmonary edema and hemorrhage, possible causes of pulmonary infection and respiratory failure in the early stage of lower spinal cord injury. Med Hypotheses, 2012, 79(3): 299-301.
21.	Tan AQ, Papadopoulos JM, Corsten AN, et al. An automated pressure-swing absorption system to administer low oxygen therapy for persons with spinal cord injury. Exp Neurol, 2020, 333: 113408.
22.	Piran SS, chulman S. Thromboprophylaxis in patients with acute spinal cord injury: a narrative review. Semin Thromb Hemost, 2019, 45(2): 150-156.
23.	Hyman G, Cardenas D. Upper-extremity deep vein thrombosis associated with peripherally inserted central catheters in acute spinal cord injury: a report of 2 cases. Arch Phys Med Rehabil, 2002, 83(9): 1313-1316.
24.	Sertic F, Diagne D, Chavez L, et al. Mid-term outcomes with the use of extracorporeal membrane oxygenation for cardiopulmonary failure secondary to massive pulmonary embolism. Eur J Cardiothorac Surg, 2020, 58(5): 923-931.
25.	Matsumoto S, Suda K, Iimoto S, et al. Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy. Spinal cord, 2015, 53(4): 306-309.
26.	Chopard R, Albertsen IE, Piazza G. Diagnosis and treatment of lower extremity venous thromboembolism: a review. JAMA, 2020, 324(17): 1765-1776.
27.	Mackiewicz-Milewska M, Cisowska-Adamiak M, Rość D, et al. Effects of four-week rehabilitation program on hemostasis disorders in patients with spinal cord injury. J Clin Med, 2020, 9(6): 1-11.
28.	Clarkson R, Mahmoud SSS, Rangan A, et al. The use of foot pumps compression devices in the perioperative management of ankle fractures: systematic review of the current literature. Foot (Edinb), 2017, 31: 61-66.
29.	Smith PC, Sarin S, Hasty J, et al. Sequential gradient pneumatic compression enhances venous ulcer healing: a randomized trial. Surgery, 1990, 108(5): 871-875.
30.	Freisinger E. Compression therapy for deep vein thrombosis - why, yes!. Vasa, 2017, 46(5): 406.
31.	Kröger K, Moerchel C. Acute deep vein thrombosis-modern diagnostics and treatment. Chirurg, 2019, 90(1): 71-84.
32.	Arabi YM, Al-Hameed F, Burns KEA, et al. Adjunctive intermittent pneumatic compression for venous thromboprophylaxis. N Engl J Med, 2019, 380(14): 1305-1315.
33.	Merli G, Crabbe S, Paluzzi R, et al. Etiology, incidence, and prevention of deep vein thrombosis in acute spinal cord injury. Arch Phys Med Rehabil, 1993, 74(11): 1199-205.
34.	Áinle FK, Evane B. Which patients are at high risk of recurrent venous thromboembolism (deep vein thrombosis and pulmonary embolism)?. Hematology Am Soc Hematol Educ Program, 2020, 2020(1): 201-212.
35.	Zhang J, Zhao K, Li J, et al. Age over 65 years and high levels of C-reactive protein are associated with the risk of preoperative deep vein thrombosis following closed distal femur fractures: a prospective cohort study. J Orthop Surg Res, 2020, 15(1): 559.
36.	Paciullo F, Bury L, Noris P, et al. Antithrombotic prophylaxis for surgery-associated venous thromboembolism risk in patients with inherited platelet disorders. The SPATA-DVT Study. Haematologica, 2020, 105(7): 1948-1956.
37.	Joffe H, Kucher N, Tapson V, et al. Few predictors of massive deep vein thrombosis. Thromb Haemost, 2005, 94(5): 986-990.
38.	Joffe H, Kucher N, Tapson V, et al. Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. Circulation, 2004, 110(12): 1605-1611.
39.	Evans R, Sharp J, Linford L, et al. Risk of symptomatic DVT associated with peripherally inserted central catheters. Chest, 2010, 138(4): 803-810.
40.	Wills B, Sheppard E, Smith W, et al. Impact of operative time on early joint infection and deep vein thrombosis in primary total hip arthroplasty. Orthop Traumatol Surg Res, 2018, 104(4): 445-448.
41.	Cho JH, Kim JB, Lee DG. Correlation between d-dimer level and deep venous thrombosis in patients with acute spinal cord injuries. Am J Phys Med Rehabil, 2020, 99(7): 613-616.
42.	Liu JM, Lan M, Zhou Y, et al. Serum concentrations of fibrinogen in patients with spinal cord injury and its relationship with neurologic function. World Neurosurg, 2017, 106: 219-223.
43.	Postma K, Bussmann JB, Haisma JA, et al. Predicting respiratory infection one year after inpatient rehabilitation with pulmonary function measured at discharge in persons with spinal cord injury. J Rehabil Med, 2009, 41(9): 729-733.
44.	Kinnear N, Barnett D, O’Callaghan M, et al. The impact of catheter-based bladder drainage method on urinary tract infection risk in spinal cord injury and neurogenic bladder: a systematic review. Neurourol Urodyn, 2020, 39(2): 854-862.

1. Hon B, Botticello A, Kirshblum S. Duplex ultrasound surveillance for deep vein thrombosis after acute traumatic spinal cord injury at rehabilitation admission. J Spinal Cord Med, 2020, 43(3): 298-305.
2. 唐进, 杨涛, 熊小江, 等. 空气波压力治疗预防全膝关节置换后下肢深静脉血栓. 中国组织工程研究, 2013, 17(52): 8981-8986.
3. Clarke M, Broderick C, Hopewell S, et al. Compression stockings for preventing deep vein thrombosis in airline passengers. Cochrane Database Syst Rev, 2016, 14(9): 1-51.
4. Green D, Rossi EC, Yao JS, et al. Deep vein thrombosis in spinal cord injury: effect of prophylaxis with calf compression, aspirin, and dipyridamole. Paraplegia, 1982, 20(4): 227-234.
5. Amin E, Bistervels I, Meijer K, et al. Reduced incidence of vein occlusion and postthrombotic syndrome after immediate compression for deep vein thrombosis. Blood, 2018, 132(21): 2298-2304.
6. Turrian U, Malloizel-Delaunay J, Bura-Rivière A. Management of upper extremity deep vein thrombosis in Occitanie: practice assessment. J Med Vasc, 2020, 45(5): 288-293.
7. Chung S, Lee S, Kim E, et al. Incidence of deep vein thrombosis after spinal cord injury: a prospective study in 37 consecutive patients with traumatic or nontraumatic spinal cord injury treated by mechanical prophylaxis. J Trauma, 2011, 71(4): 867-871.
8. 康海琼, 周红俊, 刘根林, 等. 脊髓损伤神经学分类国际标准检查表 2019 版最新修订及解读. 中国康复理论与实践, 2019, 25(8): 983-985.
9. 李建军, 周红俊, 孙迎春, 等. 脊髓损伤神经学分类国际标准(第 6 版, 2006). 中国康复理论与实践, 2008, 14(7): 693-698.
10. Su YS, Hill J, Gelman A, et al. Multiple Imputation with diagnostics (mi) in R: opening windows into the black box. J Stat Softw, 2011, 45(2): 1-31.
11. Portet S. A primer on model selection using the Akaike Information Criterion. Infect Dis Model, 2020, 5: 111-128.
12. Shaw E, Saulino M. Management strategies for spinal cord injury pain updated for the twenty-first century. Phys Med Rehabil Clin N Am, 2020, 31(3): 369-378.
13. Badhiwala JH, Wilson JR, Witiw CD, et al. The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. Lancet Neurol, 2021, 20(2): 117-126.
14. Leibinger M, Zeitler C, Gobrecht P, et al. Transneuronal delivery of hyper-interleukin-6 enables functional recovery after severe spinal cord injury in mice. Nat Commun, 2021, 12(1): 391.
15. Delparte JJ, Flett HM, Scovil CY, et al. Development of the spinal cord injury pressure sore onset risk screening (SCI-PreSORS) instrument: a pressure injury risk decision tree for spinal cord injury rehabilitation. Spinal cord, 2021, 59(2): 123-131.
16. Shams R, Drasites KP, Zaman V, et al. The pathophysiology of osteoporosis after spinal cord injury. Int J Mol Sci, 2021, 22(6): 3057.
17. Smuder AJ, Turner SM, Schuster CM, et al. Hyperbaric oxygen treatment following mid-cervical spinal cord injury preserves diaphragm muscle function. Int J Mol Sci, 2020, 21(19): 7219.
18. Ge JS, Chang TT, Zhang ZJ. Reliability of myotonometric measurement of stiffness in patients with spinal cord injury. Med Sci Monit, 2020, 26: e924811.
19. Chang SC, Zeng S, Tsai SJ. Outcome of different approaches to reduce urinary tract infection in patients with spinal cord lesions: a systematic review. Am J Phys Med Rehabil, 2020, 99(11): 1056-1066.
20. Yong T, Lili Y, Wen Y, et al. Pulmonary edema and hemorrhage, possible causes of pulmonary infection and respiratory failure in the early stage of lower spinal cord injury. Med Hypotheses, 2012, 79(3): 299-301.
21. Tan AQ, Papadopoulos JM, Corsten AN, et al. An automated pressure-swing absorption system to administer low oxygen therapy for persons with spinal cord injury. Exp Neurol, 2020, 333: 113408.
22. Piran SS, chulman S. Thromboprophylaxis in patients with acute spinal cord injury: a narrative review. Semin Thromb Hemost, 2019, 45(2): 150-156.
23. Hyman G, Cardenas D. Upper-extremity deep vein thrombosis associated with peripherally inserted central catheters in acute spinal cord injury: a report of 2 cases. Arch Phys Med Rehabil, 2002, 83(9): 1313-1316.
24. Sertic F, Diagne D, Chavez L, et al. Mid-term outcomes with the use of extracorporeal membrane oxygenation for cardiopulmonary failure secondary to massive pulmonary embolism. Eur J Cardiothorac Surg, 2020, 58(5): 923-931.
25. Matsumoto S, Suda K, Iimoto S, et al. Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy. Spinal cord, 2015, 53(4): 306-309.
26. Chopard R, Albertsen IE, Piazza G. Diagnosis and treatment of lower extremity venous thromboembolism: a review. JAMA, 2020, 324(17): 1765-1776.
27. Mackiewicz-Milewska M, Cisowska-Adamiak M, Rość D, et al. Effects of four-week rehabilitation program on hemostasis disorders in patients with spinal cord injury. J Clin Med, 2020, 9(6): 1-11.
28. Clarkson R, Mahmoud SSS, Rangan A, et al. The use of foot pumps compression devices in the perioperative management of ankle fractures: systematic review of the current literature. Foot (Edinb), 2017, 31: 61-66.
29. Smith PC, Sarin S, Hasty J, et al. Sequential gradient pneumatic compression enhances venous ulcer healing: a randomized trial. Surgery, 1990, 108(5): 871-875.
30. Freisinger E. Compression therapy for deep vein thrombosis - why, yes!. Vasa, 2017, 46(5): 406.
31. Kröger K, Moerchel C. Acute deep vein thrombosis-modern diagnostics and treatment. Chirurg, 2019, 90(1): 71-84.
32. Arabi YM, Al-Hameed F, Burns KEA, et al. Adjunctive intermittent pneumatic compression for venous thromboprophylaxis. N Engl J Med, 2019, 380(14): 1305-1315.
33. Merli G, Crabbe S, Paluzzi R, et al. Etiology, incidence, and prevention of deep vein thrombosis in acute spinal cord injury. Arch Phys Med Rehabil, 1993, 74(11): 1199-205.
34. Áinle FK, Evane B. Which patients are at high risk of recurrent venous thromboembolism (deep vein thrombosis and pulmonary embolism)?. Hematology Am Soc Hematol Educ Program, 2020, 2020(1): 201-212.
35. Zhang J, Zhao K, Li J, et al. Age over 65 years and high levels of C-reactive protein are associated with the risk of preoperative deep vein thrombosis following closed distal femur fractures: a prospective cohort study. J Orthop Surg Res, 2020, 15(1): 559.
36. Paciullo F, Bury L, Noris P, et al. Antithrombotic prophylaxis for surgery-associated venous thromboembolism risk in patients with inherited platelet disorders. The SPATA-DVT Study. Haematologica, 2020, 105(7): 1948-1956.
37. Joffe H, Kucher N, Tapson V, et al. Few predictors of massive deep vein thrombosis. Thromb Haemost, 2005, 94(5): 986-990.
38. Joffe H, Kucher N, Tapson V, et al. Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. Circulation, 2004, 110(12): 1605-1611.
39. Evans R, Sharp J, Linford L, et al. Risk of symptomatic DVT associated with peripherally inserted central catheters. Chest, 2010, 138(4): 803-810.
40. Wills B, Sheppard E, Smith W, et al. Impact of operative time on early joint infection and deep vein thrombosis in primary total hip arthroplasty. Orthop Traumatol Surg Res, 2018, 104(4): 445-448.
41. Cho JH, Kim JB, Lee DG. Correlation between d-dimer level and deep venous thrombosis in patients with acute spinal cord injuries. Am J Phys Med Rehabil, 2020, 99(7): 613-616.
42. Liu JM, Lan M, Zhou Y, et al. Serum concentrations of fibrinogen in patients with spinal cord injury and its relationship with neurologic function. World Neurosurg, 2017, 106: 219-223.
43. Postma K, Bussmann JB, Haisma JA, et al. Predicting respiratory infection one year after inpatient rehabilitation with pulmonary function measured at discharge in persons with spinal cord injury. J Rehabil Med, 2009, 41(9): 729-733.
44. Kinnear N, Barnett D, O’Callaghan M, et al. The impact of catheter-based bladder drainage method on urinary tract infection risk in spinal cord injury and neurogenic bladder: a systematic review. Neurourol Urodyn, 2020, 39(2): 854-862.

West China Medical Journal

Study on the preventive effect of pneumatic compression therapy on deep venous thrombosis of lower limbs in patients with spinal cord injury

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