Timing of deep vein thrombosis formation after aneurysmal subarachnoid hemorrhage

Abstract

OBJECT Deep vein thrombosis (DVT) is a common complication of aneurysmal subarachnoid hemorrhage (aSAH). The time period of greatest risk for developing DVT after aSAH is not currently known. aSAH induces a prothrombotic state, which may contribute to DVT formation. Using repeated ultrasound screening, the hypothesis that patients would be at greatest risk for developing DVT in the subacute post-rupture period was tested. METHODS One hundred ninety-eight patients with aSAH admitted to the Oregon Health & Science University Neurosciences Intensive Care Unit between April 2008 and March 2012 were included in a retrospective analysis. Ultrasound screening was performed every 5.2 ± 3.3 days between admission and discharge. The chi-square test was used to compare DVT incidence during different time periods of interest. Patient baseline characteristics as well as stroke severity and hospital complications were evaluated in univariate and multivariate analyses. RESULTS Forty-two (21%) of 198 patients were diagnosed with DVT, and 3 (2%) of 198 patients were symptomatic. Twenty-nine (69%) of the 42 cases of DVT were first detected between Days 3 and 14, compared with 3 cases (7%) detected between Days 0 and 3 and 10 cases (24%) detected after Day 14 (p < 0.05). The postrupture 5-day window of highest risk for DVT development was between Days 5 and 9 (40%, p < 0.05). In the multivariate analysis, length of hospital stay and use of mechanical prophylaxis alone were significantly associated with DVT formation. CONCLUSIONS DVT formation most commonly occurs in the first 2 weeks following aSAH, with detection in this cohort peaking between Days 5 and 9. Chemoprophylaxis is associated with a significantly lower incidence of DVT.

Multidisciplinary Bundle Approach in Venous Thromboembolism Prophylaxis in Patients with Non-Traumatic Subarachnoid Hemorrhage

“…Our study demonstrated no significant impact of the VTE bundle on the overall 12% incidence of VTE. This incidence is similar with the reported range noted in the literature for SAH population, typically ranging from 4.4% to 21% [1][2][3][4]9]. Furthermore, our study also identified three significant predictors of VTE -Caprini score, NSICU LOS, and the presence of baseline lung diseases.…”

“…Venous thromboembolism (VTE) remains a common morbidity in patients with subarachnoid hemorrhage (SAH). Past studies have reported the incidence of VTE ranging from 0% to as high as 24%, most occuring within the first two weeks following SAH [1,2]. The higher rate is often associated with the use lower-extremity surveillance ultrasonography, where higher rates of asymptomatic deep vein thrombosis were detected.…”

“…The higher rate is often associated with the use lower-extremity surveillance ultrasonography, where higher rates of asymptomatic deep vein thrombosis were detected. Collectively, past studies have identified various risk factors for developing VTE including immobility, presumed infections, presence of central venous catheter, older age, black race, male sex, teaching hospital, congestive heart failure, neurologic disorders, paralysis, coagulopathy, fluid and electrolyte imbalance, and obesity [1][2][3][4]. In 2015, the Neurocritical Care Society published an evidence-based guideline on Prophylaxis of Venous Thrombosis in Neurocritical Care Patients [5].…”

Chemical Versus Mechanical and Chemical Venous Thromboembolism Prophylaxis in Neurocritically Ill Patients: A Cohort Study

“…IPC is the recommended VTE strategy in this population and should be started immediately upon admission (2). UFH should be initiated as well unless in cases of unsecured ruptured aneurysms expected to undergo surgery (19). This may be extrapolated for patients undergoing endovascular treatment but data are not clear yet on this matter.…”

D-dimer is Valuable for Predicting the Extension of Isolated Distal Deep Vein Thrombosis of the Lower Limb in Neurocritical Patients: A Retrospective Observational Study

“…Acute brain injury (ABI) patients (including acute traumatic brain injury, acute hemorrhagic stroke, acute ischemic stroke and acute aneurysmal subarachnoid hemorrhage patients) who are treated in the neurocritical care unit are at high risk for deep vein thrombosis (DVT) of the lower limb; the risk varies considerably from 17-40% with different diagnostic strategies [1][2][3][4]. Isolated distal deep vein thrombosis (IDDVT) of the lower limb, also known as calf DVT, refers to infrapopliteal vein DVT that does not extend to proximal veins [5].…”