title: Risk of Venous Thromboembolism in Patients with Large Hemispheric Infarction Undergoing Decompressive Hemicraniectomy.
abstract: Deep-venous thrombosis (DVT) and pulmonary embolism (PE) are major causes of morbidity and mortality in patients with acute ischemic stroke. This study is the first to examine the risk of venous thromboembolism in patients with large hemispheric infarction undergoing decompressive hemicraniectomy.
  
  
  
  The study population included 95 consecutive patients with a large hemispheric infarction who underwent decompressive hemicraniectomy between 2006 and 2014 at our institution. All patients received prophylactic unfractionated heparin and intermittent compression devices (SCD). Patients were systematically screened for DVT at 5-day interval using Duplex ultrasound. PE was diagnosed on chest CT angiography.
  
  
  
  Mean age was 57 ± 12 years; mean BMI was 28.3 ± 7.4 kg/m(2). 30.5 % of patients had infarction in the dominant hemisphere and 69.5 % in the non-dominant hemisphere. The mean NIHSS score was 16.0 ± 5 at admission. The mean length of stay was 22 ± 17 days. 35 % of patients developed a DVT including 27 % who developed above-knee DVT and required placement of an inferior vena cava filter. In multivariable analysis, predictors of DVT were an NIHSS ≥ 17 (p = 0.007), seizures (p = 0.003), hypertension (p = 0.03), and increasing length of stay (p = 0.01). The proportion of patients who developed PE was 13 %. In multivariate analysis, BMI ≥ 30 predicted PE (p = 0.05).
  
  
  
  The rate of DVT and PE is remarkably high in patients with large hemispheric infarction undergoing decompressive hemicraniectomy despite prophylactic measures. We recommend routine screening for DVT in this population. Interventions beyond the standard prophylactic measures may be necessary in this high-risk group.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Badih
authors.initials: B
authors.lastname: Daou
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Montano
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Kent
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Kaitlyn
authors.initials: K
authors.lastname: Barkley
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.affiliation: Department of Neurosurgery, University of Iowa, Iowa City, IA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Dalyai
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA. pascal.jabbour@jefferson.edu.|Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University Hospital, 901 Walnut street 3rd Floor, Philadelphia, PA, 19107, USA. pascal.jabbour@jefferson.edu.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D000328:Adult; D000368:Aged; D020520:Brain Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*
keywords: Decompressive hemicraniectomy; Stroke; Venous thromboembolism