Fatal pulmonary embolism in spinal cord injury

Fatal pulmonary embolism (PE) is a major cause of mortality in patients with spinal cord injury. In order to ascertain those characteristics that might predict this event, we reviewed the records of all patients with autopsy-proven massive PE admitted to a regional spinal cord care center over a 5-year period. The information analyzed included patient age, sex, race, height, weight, type of accident, prior use of tobacco, alcohol, or narcotic drugs, level of injury, presence of spasticity, surgical procedures, infections, transfusions, and type of anticoagulant prophylaxis. Forty-two concurrently hospitalized patients with spinal cord injury served as control subjects. Significant differences between cases and control subjects were observed for level of injury (fewer thoracic and lumbar injuries in cases, p=0.04), less spasticity in cases (p=0.01), and greater body mass index in cases (p=0.01). There was also a trend toward more advanced age in the cases (p=0.01) and more frequent serious infections (p=0.08). Lastly, low molecular weight heparin had been used as thromboprophylaxis in a greater proportion of control subjects than cases (60 percent vs 22 percent, p=0.07), suggesting that low molecular weight heparin may be more effective in preventing fatal PE than unfractionated heparin.