Risk factors and predictors for venous thromboembolism in people with ischemic stroke: A systematic review

Abstract

Identification of individuals with ischemic stroke at particularly high risk of venous thromboembolism (VTE) is crucial for targeted thromboprophylaxis. To guide clinical decision‐making and development of risk prediction models, increased knowledge on risk factors and biomarkers is needed. Therefore, we set out to identify risk factors and predictors for VTE in people with ischemic stroke by conducting a systematic review of the literature. Medline and Embase were searched from January 1990 and onwards. Studies investigating demographic, clinical, and/or laboratory factors for stroke‐related VTE were considered. Two reviewers screened all retrieved records, independently and in duplicate. Risk of bias assessments were guided by a structured framework (PROSPERO‐ID: CRD42020176361). Of 4674 identified records, 26 studies were included. Twenty‐six demographic, clinical, and laboratory factors associated with increased risk of stroke‐related VTE after multivariable adjustments were identified. The following factors were reported by ≥2 studies: prior VTE, cancer, prestroke disability, leg weakness, increasing lesion volume of the brain infarct, infection, low Barthel Index, increasing length of hospital stay, biochemical indices of dehydration, as well as elevated levels of D‐dimer, C‐reactive protein, and homocysteine. The majority of the studies were of poor quality with moderate or high risk of bias. In conclusion, this systematic review informs on several potential risk factors and predictors for VTE in people with ischemic stroke. To improve risk stratification and guide development of risk prediction models, further confirmation is needed because there were few high‐quality studies on each factor.

Leveraging Machine Learning for Enhanced and Interpretable Risk Prediction of Venous Thromboembolism in Acute Ischemic Stroke Care

“…Among these, prominent factors such as heightened D-dimer levels, prior medication use, patient age, pre-morbid mRS, GCS, the presence of large vessel occlusion, and specific medical interventions emerged as significant predictors. These findings resonate with varying degrees of corroboration from prior research endeavors, underscoring their empirical validity (20).…”

Nomogram for Risk of Secondary Venous Thromboembolism in Stroke Patients: A Study Based on the MIMIC-IV Database

“… 17 , 18 An elevated risk of VTE is linked to elevated D-dimer levels. 19 , 20 D-dimer is a biomarker that shows promise in determining a stroke patient's likelihood of developing secondary VTE. 19 , 21 , 22 Furthermore, a study stratifying patients with different types of solid tumors according to VTE risk found that certain types of solid tumors (esophageal, lung, melanoma, ovarian, pancreatic, gastric, and uterine) were associated with a higher incidence of VTE compared to other cancer types (6.8% vs 3.9%, p < 0.001).…”

“…However, it also has limitations. Firstly, variables such as the severity of stroke upon admission, levels of C-reactive protein, 19 cancer history, 23 , 55 mechanical ventilation, and markers of severity are common risk factors for secondary VTE in stroke patients, but we did not analyze them, which may have influenced the results. Secondly, the incidence of VTE in stroke patients is lower than in the general population, 15 which may lead to model overfitting and wider confidence intervals.…”

Dehydration in geriatrics: consequences and practical guidelines

“…Thirty-day mortality rates for those who are dehydrated in hospital varied from 1.4% to 21%, and the risk of 30-day mortality was 2.54 (95% confidence interval [CI]: 1.23–5.254) higher compared to those who were hydrated [9 ▪▪ ]. More recently, it has been established that dehydration is a risk factor for venous thromboembolism [11]. Dehydration is also associated with a reduction in physical ability, depression, worse nutritional status, reduced quality of life, and overall increased mortality [12].…”