title: Ambulatory Status Protects against Venous Thromboembolism in Acute Mild Ischemic Stroke Patients.
abstract: BACKGROUND
  Ischemic stroke patients are at high risk (up to 18%) for venous thromboembolism. We conducted a retrospective cross-sectional study to understand the predictors of acute postmild ischemic stroke patient's ambulatory status and its relationship with venous thromboembolism, hospital length of stay, and in-hospital mortality.
  
  
  METHODS
  We identified 522 patients between February 2006 and May 2014 and collected data about patient demographics, admission NIHSS (National Institutes of Health Stroke Scale), venous thromboembolism prophylaxis, ambulatory status, diagnosis of venous thromboembolism, and hospital outcomes (length of stay, mortality). Chi-square test, t-test and Wilcoxon rank-sum test, and binary logistic regression were used for statistical analysis as appropriate.
  
  
  RESULTS
  A total of 61 (11.7%), 48 (9.2%), and 23 (4.4%) mild ischemic stroke patients developed venous thromboembolism, deep venous thrombosis, and pulmonary embolism, respectively. During hospitalization, 281 (53.8%) patients were ambulatory. Independent predictors of in-hospital ambulation were being married (OR 1.64, 95% CI 1.10-2.49), being nonreligious (OR 2.19, 95% CI 1.34-3.62), admission NIHSS (per unit decrease in NIHSS; OR 1.62, 95% CI 1.39-1.91), and nonuse of mechanical venous thromboembolism prophylaxis (OR 1.62, 95% CI 1.02-2.61). After adjusting for confounders, ambulatory patients had lower rates of venous thromboembolism (OR .47, 95% CI .25-.89), deep venous thrombosis (OR .36, 95% CI .17-.73), prolonged length of hospital stay (OR .24, 95% CI .16-.37), and mortality (OR .43, 95% CI .21-.84).
  
  
  CONCLUSIONS
  Our findings suggest that for hospitalized acute mild ischemic stroke patients, ambulatory status is an independent predictor of venous thromboembolism (specifically deep venous thrombosis), hospital length of stay, and in-hospital mortality.
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Jason-Flor V
authors.initials: JF
authors.lastname: Sisante
authors.affiliation: Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas; Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Abraham
authors.affiliation: Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Milind A
authors.initials: MA
authors.lastname: Phadnis
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Billinger
authors.affiliation: Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas. Electronic address: mmittal2@kumc.edu.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Mittal
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D065840:Protective Factors; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D054556:Venous Thromboembolism / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*
keywords: Ischemic stroke; ambulation; ambulatory status; deep vein thrombosis; odds ratio; protection; pulmonary embolism; venous thromboembolism