Thrombophilia in Patients with Spinal Cord Injury

Abstract number: P2325

Marcucci¹ R, Ricci² L, Fedi¹ S, Alessandrello Liotta¹ A, Rogolino¹ A, Falciani¹ M, Innocenti¹ D, Filoni¹ C, Aito² S, Abbate¹ R

¹¹Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence; Azienda Ospedaliero-Universitaria Careggi, Florence, Italy ¹¹Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence; Azienda Ospedaliero-Universitaria Careggi, Florence, Italy ²²Unit of Spinal Cord Injury, University of Florence, Florence, Italy

Deep venous thrombosis (DVT) and pulmonary embolism are major causes of morbidity and mortality in patients with spinal injuries. A wide range of thromboprophylactic measures have been proposed but the optimum treatment and duration for thromboprophylaxis is unknown. No data are available on the role of thrombophilic risk factors. Aim of our study was to determine the thrombophilic risk profile of patients with spinal cord injury (SCI) with or without a previous deep venous thrombosis by evaluating: antithrombin, protein C ans S, factor V Leiden, prothrombin polymorphism, homocysteine (Hcy), plasminogen activator inhibitor-1 (PAI.1) and lipoprotein(a) [Lp(a)]. We studied 46 patients with SCI without DVT (group A) (35 M/11 F; age: 50.5 (21–82) and 43 patients with SCI and a previous episode of DVT (group B) (34 M/9 F; age: 50 (13–78). No patient had a deficiency of clotting inhibitors, and in only 1 patient of group A we found the presence of prothrombin polymorphism. Lp(a) levels were similar in the two groups [124 (1–487) mg/L vs 84.5 (1–1079) mg/L; P= ns). Hcy and PAI-1 levels were significantly higher in group B with respect to A [Hcy: 12.3 (6.2–30.0) micromole/L vs 18.7 (5.4–35) micromole/L; P= 0.003/ PAI-1: 15.4 (1–40) IU/ml vs 10 (1–36.8) IU/mol; P= 0.008]. At the multivariate analysis adjusted for age, sex, smoking, hypertension, dyslipidemia and BMI, independent risk factors for DVT in patients with SCI were hyperHcy [OR = 3.6 (95% CI 1.4–9.5), P= 0.007] and high levels of PAI-1 [OR = 4.9 (1.7–14); P= 0.002]. Our data demonstrate that hyperHcy and impaired fibrinolysis documented by high levels of PAI-1 are independent risk factors for the occurrence of DVT in patients with SCI, suggesting the possible benefit of a vitamin supplementation.