Early DVT predictors could guide prophylaxis post-stroke
MedWire News: Prophylactic deep venous thrombosis (DVT) treatment is "reasonable" in stroke patients with normal fibrinogen levels and increased levels of C-reactive protein, report clinicians.
"Most studies addressing the issue of DVT and stroke tend to focus on patients with lower limb paresis and search for in-hospital deep venous thrombosis," note Jan Bembenek (Institute of Psychiatry and Neurology, Warsaw, Poland) and colleagues in the Journal of Thrombosis and Thrombolysis.
This approach, however, does not differentiate between early- and late-onset stroke-related DVT, which is important "as the late-onset deep venous thrombosis is mainly associated with prolonged immobility, and the early onset deep venous thrombosis may be more likely a direct consequence of the ischemic cerebrovascular event," write the investigators.
The researchers therefore looked for early predictors of stroke-related DVT in 278 patients with acute ischemic stroke and 12 patients with hemorrhagic stroke.
They report that 8.0% of patients had DVT, detected by ultrasound performed 3 days after stroke. In 3.0% of these patients, the thrombosis was new; these new cases had a 12-fold increased mortality risk in the 3 months post-stroke.
Further research showed that patients with a C-reactive protein level over 10mg/dl were nine times more likely to have DVT than those with a lower level.
Patients with DVT also had elevated fibrinogen more often that those without thrombosis. However, multivariate analysis adjusting for potential confounding factors showed that elevated fibrinogen levels were not associated with increased risk for early-onset DVT.
"In conclusion, our study shows that deep venous thrombosis, which is definitely associated with acute stroke, occurs in 3% of patients and significantly affects 3-month mortality," write the authors in the Journal of Thrombosis and Thrombolysis.
"Increased serum CRP level combined with normal fibrinogen level seems predictive for development of DVT," the investigators write.
"Therefore, it may be reasonable to provide this group of patients with additional care and proper deep venous thrombosis prophylaxis in order to minimize the risk of thromboembolic complications."
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By Philip Ford