Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke

Abstract

Background Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke. Methods Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Clinical characteristics and laboratory results, including D-dimer level, were compared between patients with and without DVT. Independent risk factors for DVT were investigated using multivariable analysis. Similar analysis was performed to identify factors associated with elevated D-dimer level (> 0.5 mg/dl) in acute ischemic stroke patients. Results During the study period, 289 patients were enrolled, and 38 (13.1%) showed DVT. Female sex (OR = 2.579, 95% CI = 1.224–5.432; p = 0.013) and a high National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.191 95% CI = 1.095–1.294; p = 0.005) were independently associated with the presence of DVT, although D-dimer level was not. Stroke mechanism, especially cardioembolic stroke (OR = 3.777, 95% CI = 1.532–9.313; p = 0.004; reference: large artery atherosclerosis), NIHSS score (OR = 1.087, 95% CI = 1.002–1.179; p = 0.001) and thrombolysis (OR = 12.360, 95% CI 2.456–62.213; p = 0.002) were independently associated with elevated abnormal D-dimer levels. Conclusion The severity of ischemic stroke, but not the D-dimer level, was associated with the presence of DVT in Asian ischemic stroke patients. D-dimer level was influenced by the stroke mechanism. LEUS in patients with severe neurological deficit, rather than screening with D-dimer, may be more beneficial for diagnosing DVT in Asian patients with acute ischemic stroke.

Association of clinical and laboratory variables with in-hospital incidence of deep vein thrombosis in patients after acute ischemic stroke

“…However, D-dimers are not very specific, they can also be elevated in some disorders without DVT. [ 32 ] A recent research in Korea concluded that female sex and a high National Institutes of Health Stroke Scale score were independently associated with the risk of DVT, while D-dimer level was not, [ 33 ] which differed from our study maybe due to the different cohorts in different countries.…”

Predictors of deep-vein thrombosis for acute stroke at admission to a rehabilitation unit: A retrospective study

“…In the present study, age at a cutoff of ≥67.5 years should raise clinical suspicion and could be used as an independent factor to predict DVT risk. Because with the increase in age, blood would gradually enter a state of hypercoagulability, and mobility would also gradually decline (3,21). Hypercoagulability and reduced mobility were easy to promote the formation of DVT, which was particularly prominent among elderly patients (22).…”

“…These stroke survivors often require early rehabilitation services after their condition stabilizes as rehabilitation services are the primary mechanism by which functional recovery and the achievement of independence are promoted in patients with AS (2). However, paralysis after AS can cause various complications, such as deep-vein thrombosis (DVT), amyotrophy, or pressure ulcers (3). Among them, DVT is one of the most common and fatal complications for patients with AS and is one of the leading causes of hindering the early rehabilitation process (4,5).…”

The Role of Vitamin D in the Relationship Between Gender and Deep Vein Thrombosis Among Stroke Patients

“…Females under 50 years old had a decreased incidence, whereas over 65 years old had a higher incidence of DVT (4). Moreover, previous studies in stroke patients also found that females had a higher risk of DVT than males (9,10). The mechanisms underlying the increased risk of DVT in females may be as follows: pregnancy (11), hormone replacement therapy (12), estrogen antagonist therapy (13) and the antiphospholipid antibody syndrome (14), hormone loss during menopause (15), oral contraceptives (OCPs) (16).…”