Deep vein thrombosis in stroke patients: An overview.
Deep vein thrombosis (DVT) is prevalent both in the acute and the later phases of stroke. From previous studies using (125)I fibrinogen uptake, its peak incidence appears to occur during the first 10 days of stroke. Using venography and impedance plethymography, its prevalence is still high (between 30% and 40%) 1 1/2 to 6 months after stroke. The incidence of pulmonary embolism appear to diminish after the acute phase of stroke. Venous stasis is a widely accepted factor in the cause of DVT. More recently, venous injury as endothelial damage from excessive venodilation has been postulated. Increased venous size in hemiplegic limb has been reported. Further studies as to the role of decreased venous velocity and increased venous size and the effect of various modalities influencing these effects are needed. Routine screening of stroke patients appears indicated, but what protocol should be followed has yet to be determined. Selective screening by stratifying patients as to their clinical risk may be appropriate if found safe and cost-effective. Prophylactic treatment should be initiated in patients who are at increased risk of DVT. The prophylaxis of venous thrombosis in stroke patients remains uncertain. The use of low-molecular heparin may be a promising option if it is proven safe, efficacious, and causes less bleeding. Other prophylactic methods remain to be investigated.
From the Neurology Service, Veterans Affairs Medical Center, and the Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, U.S.A.
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