Venous thromboembolism after acute ischemic stroke: a prospective study using magnetic resonance direct thrombus imaging.
OBJECTIVE
We prospectively evaluated the prevalence and clinical risk factors for venous thromboembolism (VTE) after acute ischemic stroke using magnetic resonance direct thrombus imaging, a highly accurate noninvasive technique that directly visualizes thrombus.Method-102 unselected patients with AIS receiving standard prophylaxis with aspirin and graded compression stockings (GCS) were sequentially recruited, underwent regular clinical assessments, and were screened for VTE.


RESULTS
The prevalence of all VTE, proximal deep vein thrombosis (PDVT), and pulmonary embolism (PE) after 21 days were 40%, 18%, and 12%, increasing to 63%, 30%, and 20% in patients with Barthel indices (BI) of < or =9 2 days after stroke (BI-2< or =9). Clinical deep vein thrombosis and PE occurred in 3% and 5% overall; half these events were overlooked by the attending team. The true incidence of clinical events is probably higher because the natural history of subclinical PDVT was modified by screening and anticoagulation. BI-2< or =9 or nonambulatory status 2 days after stroke were the clinical factors most strongly associated with subsequent VTE on univariate analysis. Odds ratios for any VTE and PDVT for BI-2< or =9 versus >9 were 8.3 (95% CI, 2.7 to 25.2) and 8.1 (95% CI, 1.7 to 38.3) on multivariable analysis.


CONCLUSIONS
BI < or =9 or nonambulatory status around the time of admission identifies a subgroup of acute ischemic stroke patients at very high risk for VTE in whom the current strategy of thromboprophylaxis may be inadequate. Future thromboprophylactic studies should focus on the patients at high risk defined in this study.
Department of Elderly Care, Guy's & St. Thomas' Hospital Trust, London, UK. jameskelly@northbrookfm.fsnet.co.uk
J
J
Kelly
A
A
Rudd
R R
RR
Lewis
C
C
Coshall
A
A
Moody
B J
BJ
Hunt
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D001458:Bandages; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000503:physiopathology*; D013923:Thromboembolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*
D005343:Fibrinolytic Agents; D001241:Aspirin