Early stroke-related deep venous thrombosis: risk factors and influence on outcome

Abstract

Deep venous thrombosis (DVT) is a serious complication of various medical conditions including acute stroke. Our aim was to identify the occurrence of early stroke-related DVT, risk factors for its development and the influence on outcome. The study involved consecutive patients admitted to our center due to acute ischaemic (n = 278) or haemorrhagic (n = 12) stroke during a 16-month period. We collected data on their pre-stroke health status, neurological deficit on admission and baseline serum CRP and fibrinogen level. Ultrasonographic imaging was performed at the 3rd (IQR: 2–4) and 9th (IQR: 8–9) day after stroke. Patients thrombosis occurring between the first and second examination comprised the newly developed early stroke-related DVT group. We found DVT in 8.0% (24/299) of patients at initial evaluation. Newly developed DVT was present in 3.0% (9/299) of patients, and was predominantly distal (7 of 9 cases). It was associated with elevated serum CRP level (OR 8.75; 95%CI: 1.61–47.6), which was verified in a model adjusted for stroke severity and pre-stroke dependency (3–5 pts. in mRS). In a multivariate model, newly developed DVT significantly increased the risk of 3-month mortality (OR 12.4; 95%CI: 1.72–89.4), without affecting the combined risk of dependency and death (OR 2.57; 95%CI: 0.39–17.0). Early stroke-related DVT is an infrequent complication. However, it may be an independent risk factor for 3-month mortality. Increased serum CRP level combined with normal fibrinogen level seems predictive for development of DVT. It may be reasonable to provide those patients with additional DVT prophylaxis.

Risk Assessment of Deep‐Vein Thrombosis After Acute Stroke: a Prospective Study Using Clinical Factors

“…Thirdly, the primary outcome in the final multivariate model was the presence of DVTs in any location, including proximal and distal DVT. The application of ultrasound has been shown to offer a limited way of detecting small and distal DVTs (63.5 vs. 94.2%) . Given the fact there is a lack of consensus on the clinical significance of symptomatic isolated distal DVT, further studies should focus on both proximal and distal DVT detection using more advanced diagnostic technology .…”

The Clots in Legs Or sTockings after Stroke (CLOTS) 3 trial: a randomised controlled trial to determine whether or not intermittent pneumatic compression reduces the risk of post-stroke deep vein thrombosis and to estimate its cost-effectiveness

“…34 There is often a delay in presenting with a stroke and there will always be some delay in applying VTE prophylaxis because the patients need to be assessed and the treatment started. In addition, in a randomised trial there may be additional delays because of the time taken to obtain consent and enrol the patients.…”

Multiple sclerosis increases the risk of venous thromboembolism: a nationwide cohort analysis

“…According to the Virchow's triad, VTE is a condition that results from altered blood coagulation, stasis or abnormalities in the vessel wall [11,12]. Previous studies have identified multiple risk factors for VTE, including age, previous VTE episodes and cerebrovascular disease (CVA) [13][14][15]. Diabetes, leg fractures, major surgery and certain cancers are also associated with increased risk of VTE [16][17][18][19].…”