Endogenous risk factors for deep-vein thrombosis in patients with acute spinal cord injuries.

ABSTRACT

STUDY DESIGN: Case-control study. AIM OF THE STUDY Investigate the presence of additional endogenous risk factors of deep-vein thrombosis (DVT). SETTING: Regional Spinal Unit of Florence, Italy. METHODS: A total of 43 patients with spinal lesion and a history of DVT during the acute stage of their neurological impairment (Group A) were comprehensively evaluated and the blood concentrations of the following risk factors, that are presumably associated with DVT, were determined antithrombin III (ATIII), protein C (PC), protein S (PS), factor V Leiden, gene 200210A polymorphism, homocysteine (Hcy), inhibitor of plasminogen activator-1 (PAI-1) and lipoprotein A (LpA). The control group (Group B) consisted of 46 patients matched to Group A for sex, age, neurological status and prophylactic treatment during the acute stage, with no history of DVT. Statistical analysis was performed using the Mann-Whitney and Fisher's exact tests. RESULTS: Of the individuals in Group A, 14% had no risk factor and 86% had at least one; however, in Group B 54% had no endogenous risk factors and 46% had at least one. None of the individuals in either group had a deficit in their coagulation inhibitors (ATIII, PC and PS), and the LpA level was equivalent in the two groups. The levels of Hcy and PAI-1 were significantly higher in Group A. CONCLUSIONS: Increases in the levels of plasma Hcy and PAI-1 are demonstrated to be independent risk factors for developing a DVT.