Systematic lower limb phlebography in acute spinal cord injury in 147 patients.

This study was concluded on paraplegic and tetraplegic patients of all aetiologies except neoplasic, where paralysis developed within 48 hours. All patients were admitted to the rehabilitation department within 90 days after the onset of paralysis. In a preliminary review of 328 files, there were 27 cases of clinical deep vein thrombosis (DVT) and 10 with pulmonary embolism (PE), 6 of which were fatal. A prospective study was conducted, based on systematic detection of asymptomatic DVT with phlebography. Among the 147 patients, 20 previously presented with DVT. The 127 others underwent phlebography which showed 39 DVT in 29 patients. Eighty seven patients with negative phlebography underwent a second study a month later which showed 14 DVT in 12 patients. Only one minor pulmonary embolism occurred in these 147 patients. The incidence of DVT after acute spinal cord injury and the frequent absence of clinical manifestations were confirmed. Prophylactic anticoagulant therapy is useful but insufficient. This study demonstrates that systematic and repeated detection of DVT by phlebography may reduce the incidence of PE.