Prophylaxis of deep venous thrombosis and adherence to guideline recommendations among inpatients with acute stroke: results from a multicenter observational longitudinal study in China.
BACKGROUND
Deep venous thrombosis (DVT) is a common complication in acute stroke. Evidence-based guidelines recommend the use of prophylactic heparins in patients with risk of DVT. We aimed to evaluate the clinical practices for DVT prophylaxis in acute stroke inpatients enrolled in a multicenter observational longitudinal study on deep venous thrombosis (Incidence of Deep Venous Thrombosis after Acute Stroke in China, INVENT-China).


METHODS
Patients' characteristics and DVT prophylaxis was extracted from the database of INVENT-China. Appropriate adherence to the guidelines was analysed.


RESULTS
Six hundred and fifty-six patients with acute stroke were eligible for analysis in this study. Pharmacologic prophylaxis with low-molecular-weight heparins (LMWH) was applied to 18 patients with ischemic stroke (3.4%) and one patient with cerebral hemorrhage. Independent factors associated with use of prophylactic anticoagulant treatment were stroke subtype (OR=0.07, 95% CI=0.01-0.78, p=0.03), baseline NIHSS score (OR=0.25, 95% CI=0.07-0.95, p=0.04), baseline motor leg function (NIHSS score) (score=1, OR=0.16, 95% CI=0.03-0.79, p=0.025; score=2, OR=0.20, 95% CI=0.05-0.84, p=0.028; score=3, OR=0.23, 95% CI=0.06-0.91, p=0.037; score=4, reference), diabetes mellitus (OR=3.86, 95% CI=1.39-10.72, p=0.009), malignancy (OR=9.55, 95% CI=1.98-46.2, p=0.005), varicose veins (OR=12.48, 95% CI=1.64-94.9, p=0.015) and central venous catheterization (OR=6.96, 95% CI=1.36-35.79, p=0.02).


CONCLUSIONS
Thromboprophylaxis is inadequate in acute stroke inpatients in China. Guidelines for prevention DVT in acute stroke should be established and efforts should be made to improve venous thromboembolism prophylaxis practice.
Zheng
Huaguang
H
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Liu
Liping
L
Sun
Haixin
H
Wang
Xianwei
X
Wang
Yilong
Y
Zhou
Yong
Y
Lu
Jingjing
J
Zhao
Xingquan
X
Wang
Chunxue
C
Dong
Kehui
K
Yang
Zhonghua
Z
Wang
Yongjun
Y
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D002985:Clinical Protocols / Q000592:standards; D015897:Comorbidity; D016208:Databases, Factual; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data* / Q000639:trends; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D015912:Thrombolytic Therapy / Q000592:standards / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014648:Varicose Veins / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight