Development of a Hypercoagulable-Hypofibrinolytic State Early After Spinal Cord Injury.
Arch Phys Med Rehabil
; 2023 Nov 15.
Article
de En
| MEDLINE
| ID: mdl-37977547
ABSTRACT
OBJECTIVES:
To determine whether spinal cord injury (SCI) is associated with adverse changes in coagulation and fibrinolytic factors that underlie thrombogenesis and contribute to atherothrombotic events such as myocardial infarctions (MIs) and strokes.DESIGN:
Cross-sectional study.SETTING:
Neurorehabilitation hospital and general community.PARTICIPANTS:
Thirty young and middle-aged (20-58 years) adults (N=30) were studied 14 non-injured community dwelling adults. (11M/4F) and 16 with subacute tetraplegic motor complete SCI during initial inpatient rehabilitation (13M/3F; time since injury 11.8±5.3 wk).INTERVENTIONS:
Not applicable. MAIN OUTCOMEMEASURES:
Circulating markers of coagulation [von Willebrand factor (vWf) and factors VII, VIII, and X], the fibrinolytic system [tissue-type plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) antigen and activity], and fibrin formation (D-dimer) were determined by enzyme immunoassay.RESULTS:
Thirty young and middle-aged (20-58 years) adults were studied 14 non-injured (11M/4F) and 16 with subacute tetraplegic motor complete SCI (13M/3F; time since injury range 4-25 wk). Circulating levels of coagulation factors VII, VIII, and X were significantly higher (â¼20%-45%; P<.05) in the adults with SCI than non-injured adults, whereas vWf was similar between groups. Fibrinolytic markers were adversely disrupted with SCI with t-PA antigen, PAI-1 antigen and PAI-1 activity were markedly higher (â¼50%-800%; P<.05) in adults with SCI compared with non-injured adults. The molar concentration ratio of active t-PA to PAI-1 was significantly higher (â¼350%) in adults with SCI. Concordant with coagulation cascade activation and fibrinolytic system inhibition, D-dimer concentrations were markedly â¼70% higher (P<.05) in adults with SCI compared with non-injured adults.CONCLUSIONS:
Subacute tetraplegic motor complete SCI is associated with a prothrombotic hemostatic profile. Adverse changes in the coagulation cascade and fibrinolytic system appear to occur early after injury and may contribute to the increased atherothrombotic risk in adults living with SCI.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Langue:
En
Journal:
Arch Phys Med Rehabil
Année:
2023
Type de document:
Article
Pays de publication:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
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UNITED STATES
/
UNITED STATES OF AMERICA
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US
/
USA