title: Deep Vein Thrombosis in the Lower Extremities in Comatose Elderly Patients with Acute Neurological Diseases.
abstract: OBJECTIVE
  Comatose elderly patients with acute neurological illness have a great risk of deep vein thrombosis (DVT). In this study, the incidence of DVT and the effectiveness of early initiation of treatment were evaluated in those patients.
  
  
  METHODS
  Total 323 patients were admitted to our ward due to neurological diseases in one year, and 43 patients, whose Glasgow Coma Scale was ≤ 11 and who was older than ≥ 60 years, were included in this study. D-dimer was measured on admission and day 7, and lower-extremity ultrasonography was performed on day 7. When DVT was positive, heparin treatment was initiated, and further evaluation of pulmonary embolism (PE) was conducted. Vena cava filter protection was inserted in PE-positive patients. Incidence of DVT and PE, alteration of D-dimer value, and effect of heparin treatment were analyzed.
  
  
  RESULTS
  DVT was positive in 19 (44.2%) patients, and PE was in 4 (9.3%). D-dimer was significantly higher in DVT-positive group on day 7 (p<0.01). No DVT were identified in patients with ischemic disease, while 66.7% of intracerebral hemorrhage and 53.3% of brain contusion patients were DVT positive. Surgery was a definite risk factor for DVT, with an odds ratio of 5.25. DVT and PE disappeared by treatment in all cases, and no patients were succumbed to the thrombosis.
  
  
  CONCLUSIONS
  Patients with hemorrhagic diseases or who undergo operation possess high risk of DVT, and initiation of heparin treatment in 7 days after admission is an effective prophylaxis for DVT in comatose elderly patients without causing bleeding.
authors: Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan. merrityamada@hotmail.co.jp.
authors: Shoko Merrit
authors: SM
authors: Yamada
authors: Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
authors: Yusuke
authors: Y
authors: Tomita
authors: Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
authors: Hideki
authors: H
authors: Murakami
authors: Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
authors: Makoto
authors: M
authors: Nakane
mesh_terms: D000208:Acute Disease; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D003128:Coma; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000627:therapeutic use; D006470:Hemorrhage / Q000453:epidemiology*; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D006493:Heparin
keywords: D-dimer; Deep vein thrombosis; elderly; heparin; pulmonary embolism