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.	中華醫學會骨科學分會. 中國骨科大手術靜脈血栓栓塞癥預防指南. 中華骨科雜志, 2016(2): 65-71.
6.	王立功, 張桂欣, 陳先, 等. 低分子量肝素聯合康復治療對脊髓損傷后下肢深靜脈血栓形成的預防作用. 中國康復醫學雜志, 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 證據預分級及證據推薦級別系統(2014 版). 護士進修雜志, 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.	全國肺栓塞和深靜脈血栓形成防治能力建設項目專家委員會《醫院內靜脈血栓栓塞癥防治質量評價與管理指南(2022 版)》編寫專家組. 醫院內靜脈血栓栓塞癥防治質量評價與管理指南(2022 版). 中華醫學雜志, 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.	上海市肺栓塞和深靜脈血栓防治聯盟, 國際血管聯盟中國分部護理專業委員會, 上海市護理學會外科護理專業委員會. 間歇充氣加壓用于靜脈血栓栓塞癥預防的中國專家共識. 中華普通外科雜志, 2022, 37(7): 549-553.
30.	國際血管聯盟中國分部護理專業委員會, 中國醫師協會腔內血管學專業委員會. 梯度壓力襪用于靜脈血栓栓塞癥防治專家共識. 介入放射學雜志, 2019, 28(9): 811-818.
31.	中華醫學會骨科學分會創傷骨科學組, 中華醫學會骨科學分會外固定與肢體重建學組, 中國醫師協會骨科醫師分會創傷專家工作委員會, 等. 中國創傷骨科患者圍手術期靜脈血栓栓塞癥預防指南(2021). 中華創傷骨科雜志, 2021, 23(3): 185-192.
32.	中國殘疾人康復協會脊髓損傷康復專業委員會. 創傷性脊柱脊髓損傷的系統管理及常見并發癥處理專家共識(2022 版). 中國老年保健醫學, 2022, 20(4): 10-15.
33.	周澤霖, 陳松海, 陳韻龍, 等. 低分子肝素對比其他抗凝藥物預防脊柱脊髓損傷后靜脈栓塞癥療效及安全性的 Meta 分析. 中國脊柱脊髓雜志, 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.	董忠禮, 趙學凌. 脊柱脊髓損傷患者深靜脈血栓預防的研究進展. 中國脊柱脊髓雜志, 2016, 26(3): 279-283.
37.	鄭櫻, 周紅俊, 劉根林, 等. 脊髓損傷并發癥的預防和治療. 中國康復理論與實踐, 2008, 14(7): 617-619.
38.	王鈺, 徐園, 王曉杰, 等. 預防關節置換術后患者發生深靜脈血栓的最佳證據總結. 中華護理雜志, 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. 中華醫學會骨科學分會. 中國骨科大手術靜脈血栓栓塞癥預防指南. 中華骨科雜志, 2016(2): 65-71.
6. 王立功, 張桂欣, 陳先, 等. 低分子量肝素聯合康復治療對脊髓損傷后下肢深靜脈血栓形成的預防作用. 中國康復醫學雜志, 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 證據預分級及證據推薦級別系統(2014 版). 護士進修雜志, 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. 全國肺栓塞和深靜脈血栓形成防治能力建設項目專家委員會《醫院內靜脈血栓栓塞癥防治質量評價與管理指南(2022 版)》編寫專家組. 醫院內靜脈血栓栓塞癥防治質量評價與管理指南(2022 版). 中華醫學雜志, 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. 上海市肺栓塞和深靜脈血栓防治聯盟, 國際血管聯盟中國分部護理專業委員會, 上海市護理學會外科護理專業委員會. 間歇充氣加壓用于靜脈血栓栓塞癥預防的中國專家共識. 中華普通外科雜志, 2022, 37(7): 549-553.
30. 國際血管聯盟中國分部護理專業委員會, 中國醫師協會腔內血管學專業委員會. 梯度壓力襪用于靜脈血栓栓塞癥防治專家共識. 介入放射學雜志, 2019, 28(9): 811-818.
31. 中華醫學會骨科學分會創傷骨科學組, 中華醫學會骨科學分會外固定與肢體重建學組, 中國醫師協會骨科醫師分會創傷專家工作委員會, 等. 中國創傷骨科患者圍手術期靜脈血栓栓塞癥預防指南(2021). 中華創傷骨科雜志, 2021, 23(3): 185-192.
32. 中國殘疾人康復協會脊髓損傷康復專業委員會. 創傷性脊柱脊髓損傷的系統管理及常見并發癥處理專家共識(2022 版). 中國老年保健醫學, 2022, 20(4): 10-15.
33. 周澤霖, 陳松海, 陳韻龍, 等. 低分子肝素對比其他抗凝藥物預防脊柱脊髓損傷后靜脈栓塞癥療效及安全性的 Meta 分析. 中國脊柱脊髓雜志, 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. 董忠禮, 趙學凌. 脊柱脊髓損傷患者深靜脈血栓預防的研究進展. 中國脊柱脊髓雜志, 2016, 26(3): 279-283.
37. 鄭櫻, 周紅俊, 劉根林, 等. 脊髓損傷并發癥的預防和治療. 中國康復理論與實踐, 2008, 14(7): 617-619.
38. 王鈺, 徐園, 王曉杰, 等. 預防關節置換術后患者發生深靜脈血栓的最佳證據總結. 中華護理雜志, 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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