Role of screening tests for deep venous thrombosis in asymptomatic adults with acute spinal cord injury - An evidence-based analysis

Study Design. Systematic review. Objective. To examine the evidence to support practice guidelines for screening for DVT in asymptomatic adults with acute traumatic spinal cord injury (SCI) who undergo pharmacologic thromboprophylaxis. Summary of Background Data. Despite the fact that pharmacologic thromboprophylaxis has been widely used since the 1980s, deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) still account for approximately 10% of deaths during the first year following SCI. Methods. MEDLINE and EMBASE were searched from the earliest achievable date to December 2005. We only included clinical studies that used a screening test for DVT and the gold standard diagnostic tests for DVT (i.e., lower limb venography) and for PE (i.e., lung arteriogram) in adults with traumatic SCI who underwent drug thromboprophylaxis during the acute stage after SCI. Results. The search yielded 188 articles, of which 9 articles fulfilled the criteria to be included in our review. Screening for DVT was performed in 3 randomized clinical trials and 6 case series. The protocol of these studies included the use of D-Dimer (1 of 9), I-125-labeled fibrinogen (2 of 9), ultrasound (1 of 9), impedance plethysmography (1 of 9), impedance plethysmography and Doppler in combination (1 of 9), Duplex (1 of 9) or venography (2 of 9) as screening test for DVT. Based on the pooled data of these studies, asymptomatic DVT was detected in 16.9% of SCI population. Only 4 studies reported the occurrence of PE in 4.4% of cases. Conclusion. There is insufficient evidence to support (or refute) a recommendation for routine screening for DVT in adults with acute traumatic SCI under thromboprophylaxis. However, there is level II-2 evidence that screening could detect asymptomatic DVT in 22.7% of those individuals. Although additional investigation is needed, we hypothesize that weekly screening for DVT during the first 13 weeks post-SCI could detect most of the asymptomatic DVT events in this patient population. D-Dimer, ultrasound, and MR venography could be considered as potentially useful screening tests for DVT in the SCI population in future research studies.