Summary of best evidence for prevention of deep vein thrombosis in lower limbs of patients with spinal cord injury_West China Medical Journal

Authors：

XUE Yuan ¹ , LI Guoqing ¹ , YE Quanyan ¹ , ZHAO Xiaoyu ¹ ,  GUO Jinli ²

1. School of Nursing, Shanxi Medical University, Taiyuan, Shanxi 030000, P. R. China;
2. Department of Nursing, the Second Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, P. R. China;

Corresponding author：

GUO Jinli, Email: gjlgbd@126.com

Keywords：

Spinal cord injury; deep vein thrombosis; thrombosis prevention; evidence summary; evidence-based nursing

DOI：

10.7507/1002-0179.202406219

Video：

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Objective To summarize the best evidence for prevention of deep vein thrombosis (DVT) in lower limbs of patients with spinal cord injury (SCI), and provide a basis for medical staff to develop evidence-based prevention and management measures for DVT in the lower limbs of patients with SCI. Methods UpToDate, BMJ Best Practice, Guidelines International Network, National Institute for Health and Clinical Excellence, Registered Nurses’ Association of Ontario, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, New Zealand Guidelines Group, JBI evidence-based healthcare center database, Web of Science, Embase, Cochrane Library, CINAHL, Medlive, China guidelines network, SinoMed, China National Knowledge Infrastructure, and Wanfang were systematically searched. Evidence related to the prevention of DVT in lower limbs of patients with SCI has been collected. The search period was from January 1, 2019 to June 30, 2024, and the literature was screened, quality evaluated, evidence extracted, and summarized. Results Finally, 22 articles were included, including 3 guidelines, 2 clinical decision-making articles, 4 best practices articles, 7 evidence summaries, 4 expert consensus articles, and 2 systematic reviews. A total of 32 pieces of evidence were ultimately formed in six aspects of risk assessment, diagnosis and screening, prevention principle, drug prevention, mechanical prevention, and health education. Conclusions There is a lot of evidence involved in the prevention of DVT in lower limbs of patients with SCI. In the clinical implementation process, medical staff can carefully choose prevention plans based on the patients’ clinical condition to reduce the incidence of DVT in patients with SCI during hospitalization.

Citation： XUE Yuan, LI Guoqing, YE Quanyan, ZHAO Xiaoyu, GUO Jinli. Summary of best evidence for prevention of deep vein thrombosis in lower limbs of patients with spinal cord injury. West China Medical Journal, 2024, 39(10): 1599-1605. doi: 10.7507/1002-0179.202406219 Copy

1.	Aito S, Pieri A, D’Andrea M, et al. Primary prevention of deep venous thrombosis and pulmonary embolism in acute spinal cord injured patients. Spinal Cord, 2002, 40(6): 300-303.
2.	Khan F, Tritschler T, Kahn SR, et al. Venous thromboembolism. Lancet, 2021, 398(10294): 64-77.
3.	Chung WS, Lin CL, Chang SN, et al. Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with spinal cord injury: a nationwide cohort prospective study. Thromb Res, 2014, 133(4): 579-584.
4.	Asady E, Ghanima W, Jelsness-Jorgensen LP, et al. Health-related quality-of-life questionnaires for deep vein thrombosis and pulmonary embolism: a systematic review on questionnaire development and methodology. Res Pract Thromb Haemost, 2021, 5(5): e12556.
5.	中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016(2): 65-71.
6.	王立功, 张桂欣, 陈先, 等. 低分子量肝素联合康复治疗对脊髓损伤后下肢深静脉血栓形成的预防作用. 中国康复医学杂志, 2009, 24(7): 656-657.
7.	Chung SB, Lee SH, Kim ES, 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): 867-870.
8.	Alper BS, Haynes RB. EBHC pyramid 5. 0 for accessing preappraised evidence and guidance. Evid Based Med, 2016, 21(4): 123-125.
9.	Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. J Clin Epidemiol, 2010, 63(12): 1308-1311.
10.	Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
11.	Aromataris E, Fernandez R, Godfrey CM, et al. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc, 2015, 13(3): 132-140.
12.	王春青, 胡雁. JBI 证据预分级及证据推荐级别系统(2014 版). 护士进修杂志, 2015(11): 964-967.
13.	National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. London: National Institute for Health and Care Excellence, 2023.
14.	全国肺栓塞和深静脉血栓形成防治能力建设项目专家委员会《医院内静脉血栓栓塞症防治质量评价与管理指南(2022 版)》编写专家组. 医院内静脉血栓栓塞症防治质量评价与管理指南(2022 版). 中华医学杂志, 2022, 102(42): 3338-3348.
15.	Nicolaides AN, Fareed J, Spyropoulos AC, et al. Prevention and management of venous thromboembolism. International consensus statement. Guidelines according to scientific evidence. Int Angiol, 2024, 43(1): 1-222.
16.	Garshick E. Respiratory complications in the adult patient with chronic spinal cord injury. Waltham: UpToDate, 2023.
17.	Benjamin E. Venous thromboembolism risk and prevention in the severely injured trauma patient. Waltham: UpToDate, 2023.
18.	Routhier N, Tagalakis V, Zarka F. Venous thromboembolism (VTE) prophylaxis. London: BMJ Best Practice, 2018.
19.	Nurboja B, Choi D. Thoracolumbar spine trauma. London: BMJ Best Practice, 2022.
20.	Chetter I. Deep vein thrombosis. London: BMJ Best Practice, 2024.
21.	Roberts LN, Arya R. Hypercoagulable state. London: BMJ Best Practice, 2024.
22.	Pearson V. Evidence summary. Venous thromboembolism: pharmacological prophylaxis for orthopedic and general surgical patients. JBI EBP, 2023: JBI-ES-5254-1.
23.	Malhotra K. Evidence summary. Orthopedic surgery: mechanical prophylaxis for venous thromboembolism. JBI EBP, 2023: JBI-ES-1048-5.
24.	Pearson V. Evidence summary. Venous thromboembolism: risk assessment. JBI EBP, 2023: JBI-ES-301-4.
25.	Queiroz ABA. Evidence summary. Venous thromboembolism: risk assessment tools for the acute medically ill. JBI EBP, 2023: JBI-ES-2781-3.
26.	JBI. Recommended practice. Venous thromboembolism: graduated compression stockings. JBI EBP, 2022: JBI-RP-4838-3.
27.	Valdez F. Evidence summary. Deep venous thrombosis prophylaxis (critically ill patient): non-pharmacological interventions. JBI EBP, 2022: JBI-ES-4023-3.
28.	JBI. Recommended practice. Venous thromboembolism (VTE) intensive care unit (ICU): prevention and prophylaxis. JBI EBP, 2021: JBI-RP-4813-2.
29.	上海市肺栓塞和深静脉血栓防治联盟, 国际血管联盟中国分部护理专业委员会, 上海市护理学会外科护理专业委员会. 间歇充气加压用于静脉血栓栓塞症预防的中国专家共识. 中华普通外科杂志, 2022, 37(7): 549-553.
30.	国际血管联盟中国分部护理专业委员会, 中国医师协会腔内血管学专业委员会. 梯度压力袜用于静脉血栓栓塞症防治专家共识. 介入放射学杂志, 2019, 28(9): 811-818.
31.	中华医学会骨科学分会创伤骨科学组, 中华医学会骨科学分会外固定与肢体重建学组, 中国医师协会骨科医师分会创伤专家工作委员会, 等. 中国创伤骨科患者围手术期静脉血栓栓塞症预防指南(2021). 中华创伤骨科杂志, 2021, 23(3): 185-192.
32.	中国残疾人康复协会脊髓损伤康复专业委员会. 创伤性脊柱脊髓损伤的系统管理及常见并发症处理专家共识(2022 版). 中国老年保健医学, 2022, 20(4): 10-15.
33.	周泽霖, 陈松海, 陈韵龙, 等. 低分子肝素对比其他抗凝药物预防脊柱脊髓损伤后静脉栓塞症疗效及安全性的 Meta 分析. 中国脊柱脊髓杂志, 2023, 33(1): 51-61.
34.	Zheng R, Guan B, Fan Y, et al. A critical appraisal of clinical practice guidelines for management of four common complications after spinal cord injury. Spine J, 2023, 23(6): 888-899.
35.	Wells PS, Anderson DR, Rodger M, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med, 2003, 349(13): 1227-1235.
36.	董忠礼, 赵学凌. 脊柱脊髓损伤患者深静脉血栓预防的研究进展. 中国脊柱脊髓杂志, 2016, 26(3): 279-283.
37.	郑樱, 周红俊, 刘根林, 等. 脊髓损伤并发症的预防和治疗. 中国康复理论与实践, 2008, 14(7): 617-619.
38.	王钰, 徐园, 王晓杰, 等. 预防关节置换术后患者发生深静脉血栓的最佳证据总结. 中华护理杂志, 2021, 56(9): 1408-1414.

1. Aito S, Pieri A, D’Andrea M, et al. Primary prevention of deep venous thrombosis and pulmonary embolism in acute spinal cord injured patients. Spinal Cord, 2002, 40(6): 300-303.
2. Khan F, Tritschler T, Kahn SR, et al. Venous thromboembolism. Lancet, 2021, 398(10294): 64-77.
3. Chung WS, Lin CL, Chang SN, et al. Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with spinal cord injury: a nationwide cohort prospective study. Thromb Res, 2014, 133(4): 579-584.
4. Asady E, Ghanima W, Jelsness-Jorgensen LP, et al. Health-related quality-of-life questionnaires for deep vein thrombosis and pulmonary embolism: a systematic review on questionnaire development and methodology. Res Pract Thromb Haemost, 2021, 5(5): e12556.
5. 中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016(2): 65-71.
6. 王立功, 张桂欣, 陈先, 等. 低分子量肝素联合康复治疗对脊髓损伤后下肢深静脉血栓形成的预防作用. 中国康复医学杂志, 2009, 24(7): 656-657.
7. Chung SB, Lee SH, Kim ES, 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): 867-870.
8. Alper BS, Haynes RB. EBHC pyramid 5. 0 for accessing preappraised evidence and guidance. Evid Based Med, 2016, 21(4): 123-125.
9. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. J Clin Epidemiol, 2010, 63(12): 1308-1311.
10. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
11. Aromataris E, Fernandez R, Godfrey CM, et al. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc, 2015, 13(3): 132-140.
12. 王春青, 胡雁. JBI 证据预分级及证据推荐级别系统(2014 版). 护士进修杂志, 2015(11): 964-967.
13. National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. London: National Institute for Health and Care Excellence, 2023.
14. 全国肺栓塞和深静脉血栓形成防治能力建设项目专家委员会《医院内静脉血栓栓塞症防治质量评价与管理指南(2022 版)》编写专家组. 医院内静脉血栓栓塞症防治质量评价与管理指南(2022 版). 中华医学杂志, 2022, 102(42): 3338-3348.
15. Nicolaides AN, Fareed J, Spyropoulos AC, et al. Prevention and management of venous thromboembolism. International consensus statement. Guidelines according to scientific evidence. Int Angiol, 2024, 43(1): 1-222.
16. Garshick E. Respiratory complications in the adult patient with chronic spinal cord injury. Waltham: UpToDate, 2023.
17. Benjamin E. Venous thromboembolism risk and prevention in the severely injured trauma patient. Waltham: UpToDate, 2023.
18. Routhier N, Tagalakis V, Zarka F. Venous thromboembolism (VTE) prophylaxis. London: BMJ Best Practice, 2018.
19. Nurboja B, Choi D. Thoracolumbar spine trauma. London: BMJ Best Practice, 2022.
20. Chetter I. Deep vein thrombosis. London: BMJ Best Practice, 2024.
21. Roberts LN, Arya R. Hypercoagulable state. London: BMJ Best Practice, 2024.
22. Pearson V. Evidence summary. Venous thromboembolism: pharmacological prophylaxis for orthopedic and general surgical patients. JBI EBP, 2023: JBI-ES-5254-1.
23. Malhotra K. Evidence summary. Orthopedic surgery: mechanical prophylaxis for venous thromboembolism. JBI EBP, 2023: JBI-ES-1048-5.
24. Pearson V. Evidence summary. Venous thromboembolism: risk assessment. JBI EBP, 2023: JBI-ES-301-4.
25. Queiroz ABA. Evidence summary. Venous thromboembolism: risk assessment tools for the acute medically ill. JBI EBP, 2023: JBI-ES-2781-3.
26. JBI. Recommended practice. Venous thromboembolism: graduated compression stockings. JBI EBP, 2022: JBI-RP-4838-3.
27. Valdez F. Evidence summary. Deep venous thrombosis prophylaxis (critically ill patient): non-pharmacological interventions. JBI EBP, 2022: JBI-ES-4023-3.
28. JBI. Recommended practice. Venous thromboembolism (VTE) intensive care unit (ICU): prevention and prophylaxis. JBI EBP, 2021: JBI-RP-4813-2.
29. 上海市肺栓塞和深静脉血栓防治联盟, 国际血管联盟中国分部护理专业委员会, 上海市护理学会外科护理专业委员会. 间歇充气加压用于静脉血栓栓塞症预防的中国专家共识. 中华普通外科杂志, 2022, 37(7): 549-553.
30. 国际血管联盟中国分部护理专业委员会, 中国医师协会腔内血管学专业委员会. 梯度压力袜用于静脉血栓栓塞症防治专家共识. 介入放射学杂志, 2019, 28(9): 811-818.
31. 中华医学会骨科学分会创伤骨科学组, 中华医学会骨科学分会外固定与肢体重建学组, 中国医师协会骨科医师分会创伤专家工作委员会, 等. 中国创伤骨科患者围手术期静脉血栓栓塞症预防指南(2021). 中华创伤骨科杂志, 2021, 23(3): 185-192.
32. 中国残疾人康复协会脊髓损伤康复专业委员会. 创伤性脊柱脊髓损伤的系统管理及常见并发症处理专家共识(2022 版). 中国老年保健医学, 2022, 20(4): 10-15.
33. 周泽霖, 陈松海, 陈韵龙, 等. 低分子肝素对比其他抗凝药物预防脊柱脊髓损伤后静脉栓塞症疗效及安全性的 Meta 分析. 中国脊柱脊髓杂志, 2023, 33(1): 51-61.
34. Zheng R, Guan B, Fan Y, et al. A critical appraisal of clinical practice guidelines for management of four common complications after spinal cord injury. Spine J, 2023, 23(6): 888-899.
35. Wells PS, Anderson DR, Rodger M, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med, 2003, 349(13): 1227-1235.
36. 董忠礼, 赵学凌. 脊柱脊髓损伤患者深静脉血栓预防的研究进展. 中国脊柱脊髓杂志, 2016, 26(3): 279-283.
37. 郑樱, 周红俊, 刘根林, 等. 脊髓损伤并发症的预防和治疗. 中国康复理论与实践, 2008, 14(7): 617-619.
38. 王钰, 徐园, 王晓杰, 等. 预防关节置换术后患者发生深静脉血栓的最佳证据总结. 中华护理杂志, 2021, 56(9): 1408-1414.

West China Medical Journal

Summary of best evidence for prevention of deep vein thrombosis in lower limbs of patients with spinal cord injury

Abstract Full text Figures/Tables Video References Cited by

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