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Chiropractic Research Review

A Model to Discuss Risk Factors, Stroke

Practitioners often struggle to understand the potential risk of vertebrobasilar insufficiency (VBI) related to cervical manipulation. This article discusses the interactions between various risk factors and thrombus formation.

The authors offer a model for clinicians and researchers to use in their discussion of manipulation of the cervical spine and vertebrobasilar stroke. They have modified Virchow's Triad to look at the interaction between thrombus formation and three factors: endothelial injury, abnormal blood flow, and hypercoagulability as it relates to the chiropractic patient.

Endothelial injury can initiate intrinsic and extrinsic coagulation cascades, resulting in thrombus formation. Causes of endothelial injury may include hypertension, atherosclerosis, and chemical injury, as well as direct physical injury, such as twisting or tearing of blood vessels.

Abnormal blood flow can create turbulence, which can activate the clotting process. Creation of turbulence due to vertebral artery anomalies, congenital malformations, or neck positions such as rotation, are thought to be possible factors in thrombus formation.

Hypercoagulability is the increased tendency of the blood to clot. The factors that predispose an individual to hypercoagulability include, but are not limited to, cigarette smoking; diabetes; hypertension; cancer; oral contraceptive use; and obesity.

The authors suggest that chiropractors consider a multitude of factors when managing patients. They state that "the overlapping areas serve to arouse heightened clinical suspicion whenever patients present with multiple risk factors for VBI that place them in these areas."

Symons BP, Westaway M. Virchow's Triad and spinal manipulative therapy of the cervical spine. Journal of the Canadian Chiropractic Association 2001:45(4), pp. 225-231. Free full text on line at www.jcca-online.org.

Chiropractic Research Review

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