Correlation Between D-Dimer Level and Deep Venous Thrombosis in Patients With Acute Spinal Cord Injuries.
Jang Hyuk Cho, Jong Bum Kim, Dong Gyu Lee
PMID 31996567WHAT IT FOUND
D-dimer was higher in acute spinal cord injury patients with deep vein thrombosis.
It fell as time since injury increased, and was higher with lower-limb weakness or trauma, but weakness and trauma did not track with thrombosis.
Key findings
01Fourteen of 45 patients had DVT, and mean D-dimer was 6.98 μg/ml in the DVT-positive group versus 2.15 μg/ml in the DVT-negative group.
02D-dimer decreased as the time from injury to testing increased, and lower-limb motor score was correlated with D-dimer, but motor scores were not correlated with DVT occurrence.
03Traumatic SCI had higher mean D-dimer than nontraumatic SCI (5.54 versus 2.51 μg/ml; P = 0.006).
STILL TO COME
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What it does not show
Only 45 patients were included in this retrospective chart review, and the design looked at existing records rather than a planned intervention. D-dimer testing was not done at a fixed time after injury; it occurred at transfer to rehabilitation, with intervals from 5 to 90 days. The study did not evaluate pulmonary embolism, so it could not interpret the full range of venous thromboembolism. Elderly patients and patients admitted for comorbidities other than spinal cord injury were excluded, so the results may not apply to those groups. All patients had not received pharmacological thromboprophylaxis, so the findings may not apply to patients on clot-prevention medication. D-dimer can be increased by trauma, immobility, infection, and recent surgery, and tissue injury after trauma may falsely raise it. Duplex ultrasonography has lower sensitivity and specificity for distal and small-vessel DVT, and some pulmonary embolism patients did not have DVT. Motor scores did not correlate with DVT occurrence, so paralysis severity cannot be used to predict DVT in this study.
Declared interests
The authors declared no potential conflicts of interest. No funding source is stated in the supplied text.
The easy way to misread this
Do not read a high D-dimer as proof of deep vein thrombosis in acute spinal cord injury. Trauma, time since injury, and lower-limb weakness were also associated with higher D-dimer, and motor scores were not linked to thrombosis.