Clinical and laboratory predictors of deep vein thrombosis after acute stroke.
BACKGROUND
Deep vein thrombosis (DVT) is a common complication of acute stroke, but the new incidence in the era of improved specialist input in stroke care is yet unknown. The models for VTE diagnosis is well established, but prediction models to target at-risk patients for pharmacological prophylaxis is lacking and requires further research, particularly in the aftermath of acute stroke.


OBJECTIVE
To predict DVT after acute stroke using markers of haemostatic activation and stroke severity scores.


METHODS
We examined the clinical utility of laboratory factors such as thrombin generation, D-dimer, fibrinogen alongside clinical factors (National Institute of Health Stroke Scale and Barthel Index) in the prediction of asymptomatic DVT, among 92 consecutively admitted patients.


RESULTS
One in five patients (19.6%) had objectively confirmed DVT (6 proximal, 12 distal). Thrombolytic therapy did not protect against DVT, with 21% (6/29) of patients treated with r-tPA went on to develop DVT. Thrombin generation and fibrinogen had no clinical utility, but D-dimer at baseline and week 2 had high clinical potential in the prediction of asymptomatic DVT (2425ng/mL versus 1010ng/mL; p=0.001) and (2240 Vs 970ng/mL; p<0.001) respectively. Patients with DVT had worse stroke severity, and are functionally less able, with lower Barthel index (p=0.05), and high National Institute of Health Stroke Score (p=0.07).


CONCLUSIONS
Thrombolytic therapy and specialist stroke intervention does not protect against DVT risk. D-dimer concentration within 48h of acute stroke is independently associated with development of DVT. This observation would require confirmation in a large study.
King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Stroke Medicine, East Kent Hospitals University NHS Foundation Trust, East Kent, UK. Electronic address: Ibrahim.balogun@nhs.net.
Ibrahim O
IO
Balogun
King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
Lara N
LN
Roberts
King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
Raj
R
Patel
Department of Stroke Medicine, King's College Hospital NHS Foundation Trust, London, UK.
Rohan
R
Pathansali
Clinical Neuroscience Department, Academic Neuroscience Centre, King's College London, UK.
Lalit
L
Kalra
King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
Roopen
R
Arya
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000150:complications*; D013917:Thrombin / Q000032:analysis; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D013917:Thrombin