Vennous Thromboembolism is Associated with Lack of Vitamin D Supplementation in Patients with Spinal Cord Injury and Low Vitamin D Levels
Physical Medicine and Rehabilitation https://doi.org/10.1016/j.pmrj.2018.09.038
Reza Ehsanian MD PhD1234, Molly A.Timmerman DO 35 Jerry M.Wright MS2 Stephen McKenna MD 124, Ben Dirlikov 2 James Crew MD 123
1 Physical Medicine and Rehabilitation Department at Santa Clara Valley Medical Center, San Jose, CA
2 Rehabilitation Research Center at Santa Clara Valley Medical Center, San Jose, CA
3 Physical Medicine and Rehabilitation Division, Department of Orthopaedic Surgery, Stanford University, Palo Alto, CA
4 Department of Neurosurgery, Stanford University, Palo Alto, CA
5 Physical Medicine and Rehabilitation Department at Veterans Health Administration, Palo Alto, CA
Unfortunately the abstract does not indicate the dose size nor when it was given
- Spinal Cord category listing has
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Note: Vitamin D and Vitamin K are both anticoagulants
- Decreased need for warfarin after Vitamin D levels optimized – RCT May 2016
- Hypothesis – Use of anticoagulants with COPD lowers Vitamin K, which increases calcification – Nov 2017
The role of vitamin D (VitD) in the pathogenesis of venous thromboembolism (VTE) and prevalence of low VitD (LVitD) in spinal cord injury (SCI) has motivated VitD testing and supplementation. This is an exploratory study of data collected at a time before the routine clinical practice of VitD supplementation, allowing for evaluation of the natural history of LVitD levels in patients with SCI.
Objective: To determine if VitD supplementation in persons with SCI and LVitD levels is associated with decreased prevalence of VTE.
Design: Retrospective cohort study.
Setting: Rehabilitation Center at Level I Trauma Center.
Participants: Patients with SCI admitted to acute inpatient rehabilitation (N=282).
Main Outcome Measures: VTE prevalence in patients with LVitD levels, grouped by presence or absence of VitD supplementation.
Of the acute inpatient SCI population, 80% (227/282) demonstrated VitD levels < 30 ng/mL (LVitD). Although the incidence of VTE was almost double in the LVitD group, 19% (43/227) of the patients in the LVitD group had VTE versus 9% (5/55) of patients with VitD levels > 30 ng/mL (Normal VitD, NVitD), it did not achieve statistical significance (P=.108, V=.104). When the role of VitD supplementation was analyzed, individuals in the LVitD group who received no VitD supplementation (LVitDSuppNegative) had a statistically significant higher incidence of VTE compared to the LVitD group with VitD supplementation (LVitDSuppPositive) (24% [42/178] versus 2% [1/49]) (P<.001, V=.226). In post-hoc exploratory analyses, the VTE rate of patients in the LVitDSuppNegative group was noted to be significantly higher than all other patient groups combined (P<.001, V=.229). A binary logistic regression model incorporating clinical covariates also showed this grouping to be significant.
Conclusion: A significant association appears to exist between lack of VitD supplementation and VTE occurrence in persons with acute SCI and LVitD levels.
This study was presented as a poster presentation at 2017 AAPM&R’s Annual Assembly.Deep vein blood clots 12X more frequent in SCI patients who did not get vitamin D supplements – Oct 2018
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