D-dimer screening for deep venous thrombosis in traumatic cervical spinal injuries


      Background context

      Deep venous thrombosis (DVT) in spinal cord injury (SCI) patients is a life-threatening comorbidity. Despite its seriousness, prophylaxis and screening for DVT in SCI patients are still not sophisticated.


      This study aimed to define the epidemiology and incidence of DVT in acute traumatic cervical SCI in a Japanese population, determine the best timing for DVT screening, and determine the optimal D-dimer threshold level for use as an easy and minimally invasive screening tool.

      Study design

      This is a prospective clinical study.

      Patient sample

      The patient sample included acute traumatic cervical SCI patients who were admitted to our facility within 2 weeks after injury.

      Outcome measure

      Multivariate logistic regression was performed for outcome measure.


      We enrolled 268 patients (223 men and 45 women), from April 2007 to December 2012. After excluding early drop-out patients, 211 patients remained. Assessment for neurological status and blood chemistry, especially blood coagulation levels (prothrombin time, prothrombin time-international normalized ratio, activated partial thromboplastin time, and serum D-dimer), was performed every week until 1 month after injury. Ultrasonography was performed for DVT detection every 2 weeks.


      Deep venous thromboses were detected in 22 patients (10.4% of patients studied). All DVT-positive patients demonstrated severe paralysis classified as C or greater on the American Spinal Injury Association (ASIA) Impairment Scale. Multivariate logistic regression of clinical and laboratory parameters revealed that only the D-dimer level at 2 weeks after injury was an accurate predictor of DVT formation. The optimal threshold of D-dimer for prediction was determined to be 16 μg/dL. The sensitivity and specificity for detecting DVT were 77.3% and 69.2%, respectively.


      D-dimer levels may be used to predict the likelihood of DVT development in patients with acute cervical SCI. Furthermore, the optimal timing for screening test by D-dimer is 2 weeks after injury, and optimal threshold level for D-dimer for diagnosing DVT is 16 μg/dL. Such a screening test would be cost-efficient and simple to administer and could then be followed with additional investigations, such as ultrasonography or venography.


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        • Geerts W.H.
        • Bergqvist D.
        • Pineo G.F.
        • Heit J.A.
        • Samama C.M.
        • Lassen M.R.
        • et al.
        Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).
        Chest. 2008; 133: 381S-453S
        • Germing A.
        • Schakrouf M.
        • Lindstaedt M.
        • Grewe P.
        • Meindl R.
        • Mugge A.
        Serial compression B-scan and Doppler sonography for the screening of deep venous thrombosis in patients with spinal cord injuries.
        J Clin Ultrasound. 2010; 38: 17-20
        • Sakai H.
        • Ueta T.
        • Shiba K.
        Current situation of medical care for spinal cord injury in Japan.
        J Spine Res. 2010; 1: 41-51
        • Riklin C.
        • Baumberger M.
        • Wick L.
        • Michel D.
        • Sauter B.
        • Knecht H.
        Deep vein thrombosis and heterotopic ossification in spinal cord injury: a 3 year experience at the Swiss Paraplegic Centre Nottwil.
        Spinal Cord. 2003; 41: 192-198
        • Myllynen P.
        • Kammonen M.
        • Rokkanen P.
        • Bostman O.
        • Lalla M.
        • Laasonen E.
        Deep venous thrombosis and pulmonary embolism in patients with acute spinal cord injury: a comparison with nonparalyzed patients immobilized due to spinal fractures.
        J Trauma. 1985; 25: 541-543
        • Rathore M.F.
        • Hanif S.
        • New P.W.
        • Butt A.W.
        • Aasi M.H.
        • Khan S.U.
        The prevalence of deep vein thrombosis in a cohort of patients with spinal cord injury following the Pakistan earthquake of October 2005.
        Spinal Cord. 2008; 46: 523-526
        • Saraf S.K.
        • Rana R.J.
        • Sharma O.P.
        Venous thromboembolism in acute spinal cord injury patients.
        Indian J Orthop. 2007; 41: 194-197
        • Sugimoto Y.
        • Ito Y.
        • Tomioka M.
        • Tanaka M.
        • Hasegawa Y.
        • Nakago K.
        • et al.
        Deep venous thrombosis in patients with acute cervical spinal cord injury in a Japanese population: assessment with Doppler ultrasonography.
        J Orthop Sci. 2009; 14: 374-376
        • Maxwell R.A.
        • Chavarria-Aguilar M.
        • Cockerham W.T.
        • Lewis P.L.
        • Barker D.E.
        • Durham R.M.
        • et al.
        Routine prophylactic vena cava filtration is not indicated after acute spinal cord injury.
        J Trauma. 2002; 52: 902-906
        • Colachis III, S.C.
        • Clinchot D.M.
        The association between deep venous thrombosis and heterotopic ossification in patients with acute traumatic spinal cord injury.
        Paraplegia. 1993; 31: 507-512
        • Aito S.
        • Pieri A.
        • D'Andrea M.
        • Marcelli F.
        • Cominelli E.
        Primary prevention of deep venous thrombosis and pulmonary embolism in acute spinal cord injured patients.
        Spinal Cord. 2002; 40: 300-303
        • Virchow R.
        Gesammelte Abhandlungen zur Wissenschaftlichen Medizin.
        Meidinger Sohn, Frankfurt, Germany1856
        • Aito S.
        • Abbate R.
        • Marcucci R.
        • Cominelli E.
        Endogenous risk factors for deep-vein thrombosis in patients with acute spinal cord injuries.
        Spinal Cord. 2007; 45: 627-631
        • Boudaoud L.
        • Roussi J.
        • Lortat-Jacob S.
        • Bussel B.
        • Dizien O.
        • Drouet L.
        Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury.
        Spinal Cord. 1997; 35: 151-157
        • Iversen P.O.
        • Groot P.D.
        • Hjeltnes N.
        • Andersen T.O.
        • Mowinckel M.C.
        • Sandset P.M.
        Impaired circadian variations of haemostatic and fibrinolytic parameters in tetraplegia.
        Br J Haematol. 2002; 119: 1011-1016
        • Chung S.B.
        • Lee S.H.
        • Kim E.S.
        • Eoh W.
        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 (discussion 70–71): 867-870
        • Furlan J.C.
        • Fehlings M.G.
        Role of screening tests for deep venous thrombosis in asymptomatic adults with acute spinal cord injury: an evidence-based analysis.
        Spine. 2007; 32: 1908-1916
        • Haut E.R.
        • Schneider E.B.
        • Patel A.
        • Streiff M.B.
        • Haider A.H.
        • Stevens K.A.
        • et al.
        Duplex ultrasound screening for deep vein thrombosis in asymptomatic trauma patients: a survey of individual trauma surgeon opinions and current trauma center practices.
        J Trauma. 2011; 70 (discussion -4): 27-33
        • Kadyan V.
        • Clinchot D.M.
        • Mitchell G.L.
        • Colachis S.C.
        Surveillance with duplex ultrasound in traumatic spinal cord injury on initial admission to rehabilitation.
        J Spinal Cord Med. 2003; 26: 231-235
        • Powell M.
        • Kirshblum S.
        • O'Connor K.C.
        Duplex ultrasound screening for deep vein thrombosis in spinal cord injured patients at rehabilitation admission.
        Arch Phys Med Rehabil. 1999; 80: 1044-1046
        • Akman M.N.
        • Cetin N.
        • Bayramoglu M.
        • Isiklar I.
        • Kilinc S.
        Value of the D-dimer test in diagnosing deep vein thrombosis in rehabilitation inpatients.
        Arch Phys Med Rehabil. 2004; 85: 1091-1094
        • Wells P.S.
        • Anderson D.R.
        • Rodger M.
        • Forgie M.
        • Kearon C.
        • Dreyer J.
        • et al.
        Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis.
        N Engl J Med. 2003; 349: 1227-1235
        • Linkins L.A.
        • Bates S.M.
        • Lang E.
        • Kahn S.R.
        • Douketis J.D.
        • Julian J.
        • et al.
        Selective D-dimer testing for diagnosis of a first suspected episode of deep venous thrombosis: a randomized trial.
        Ann Intern Med. 2013; 158: 93-100
        • Audibert G.
        • Faillot T.
        • Vergnes M.C.
        • Bosson J.L.
        • Bernard C.
        • Payen J.F.
        • et al.
        Thromboprophylaxis in elective spinal surgery and spinal cord injury.
        Ann Fr Anesth Reanim. 2005; 24: 928-934
        • Roussi J.
        • Bentolila S.
        • Boudaoud L.
        • Casadevall N.
        • Vallee C.
        • Carlier R.
        • et al.
        Contribution of D-dimer determination in the exclusion of deep venous thrombosis in spinal cord injury patients.
        Spinal Cord. 1999; 37: 548-552