Development of a hypercoagulable-hypofibrinolytic state early after spinal cord injury

Abstract

Abstract Study Design: Cross sectional study. Objectives: To determine whether spinal cord injury (SCI) is associated with adverse changes in coagulation and fibrinolytic factors that underlie thrombogenesis and contribute to atherothrombotic events such as myocardial infarctions (MI) and strokes. Setting: Adults with subacute SCI and non-injured community dwelling adults. Methods: Thirty young and middle-aged (20-58 years) adults were studied: 14 non-injured (11M/4F) and 16 with subacute SCI (13M/3F; time since injury: 11.8±5.3 wk). Circulating markers of coagulation [von Willebrand factor (vWf) and factors VII, VIII, and X], the fibrinolytic system [tissue-type plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) antigen and activity], and fibrin formation (D-dimer) were determined by enzyme immunoassay. Results: Circulating levels of coagulation factors VII, VIII and X were significantly higher (~20-45%) in the adults with SCI than non-injured adults; whereas, vWf was similar between groups. Fibrinolytic markers were adversely disrupted with SCI with t-PA antigen, PAI-1 antigen and PAI-1 activity were markedly higher (~50-800%; P<0.05) in adults with SCI compared with non-injured adults. The molar concentration ratio of active t-PA to PAI-1 was significantly higher (~350%) in adults with SCI. Concordant with coagulation cascade activation and fibrinolytic system inhibition, D-dimer concentrations were markedly ~70% higher (P<0.05) in adults with SCI compared with non-injured adults. Conclusions: Subacute tetraplegic motor complete SCI is associated with a prothrombotic hemostatic profile. Adverse changes in the coagulation cascade and fibrinolytic system appear to occur early after injury and may contribute to the increased atherothrombotic risk in adults living with SCI.