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Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke.

ABSTRACT: BACKGROUND:Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke. METHODS:Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Clinical characteristics and laboratory results, including D-dimer level, were compared between patients with and without DVT. Independent risk factors for DVT were investigated using multivariable analysis. Similar analysis was performed to identify factors associated with elevated D-dimer level (>?0.5?mg/dl) in acute ischemic stroke patients. RESULTS:During the study period, 289 patients were enrolled, and 38 (13.1%) showed DVT. Female sex (OR?=?2.579, 95% CI?=?1.224-5.432; p?=?0.013) and a high National Institutes of Health Stroke Scale (NIHSS) score (OR?=?1.191 95% CI?=?1.095-1.294; p?=?0.005) were independently associated with the presence of DVT, although D-dimer level was not. Stroke mechanism, especially cardioembolic stroke (OR?=?3.777, 95% CI?=?1.532-9.313; p?=?0.004; reference: large artery atherosclerosis), NIHSS score (OR?=?1.087, 95% CI?=?1.002-1.179; p?=?0.001) and thrombolysis (OR?=?12.360, 95% CI 2.456-62.213; p?=?0.002) were independently associated with elevated abnormal D-dimer levels. CONCLUSION:The severity of ischemic stroke, but not the D-dimer level, was associated with the presence of DVT in Asian ischemic stroke patients. D-dimer level was influenced by the stroke mechanism. LEUS in patients with severe neurological deficit, rather than screening with D-dimer, may be more beneficial for diagnosing DVT in Asian patients with acute ischemic stroke.

SUBMITTER: Ha SH

PROVIDER: S-EPMC7320547 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke.

Ha Sang Hee SH Kim Yeon-Jung YJ Heo Sung Hyuk SH Chang Dae-Il DI Kim Bum Joon BJ

BMC neurology 20200627 1

<h4>Background</h4>Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke.<h4>Methods</h4>Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Clinical characteristics and laboratory results, including D-dimer level, we ...[more]

PMID: 32593290

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Project description:ObjectiveThe pandemic of coronavirus disease 2019 (COVID-19) has caused devastating morbidity and mortality worldwide. In particular, thromboembolic complications have emerged as a key threat for patients with COVID-19. We assessed our experience with deep vein thrombosis (DVT) in patients with COVID-19.MethodsWe performed a retrospective analysis of all patients with COVID-19 who had undergone upper or lower extremity venous duplex ultrasonography at an academic health system in New York City from March 3, 2020 to April 12, 2020 with follow-up through May 12, 2020. A cohort of hospitalized patients without COVID-19 (non-COVID-19) who had undergone venous duplex ultrasonography from December 1, 2019 to December 31, 2019 was used for comparison. The primary outcome was DVT. The secondary outcomes included pulmonary embolism, in-hospital mortality, admission to the intensive care unit, and antithrombotic therapy. Multivariable logistic regression was performed to identify the risk factors for DVT and mortality.ResultsOf 443 patients (COVID-19, n = 188; and non-COVID-19, n = 255) who had undergone venous duplex ultrasonography, the COVID-19 cohort had had a greater incidence of DVT (31% vs 19%; P = .005) than had the non-COVID-19 cohort. The incidence of pulmonary embolism was not significantly different statistically between the COVID-19 and non-COVID-19 cohorts (8% vs 4%; P = .105). The DVT location in the COVID-19 group was more often distal (63% vs 29%; P < .001) and bilateral (15% vs 4%; P < .001). The duplex ultrasound findings had a significant impact on the antithrombotic plan; 42 patients (72%) with COVID-19 in the DVT group had their therapy escalated and 49 (38%) and 3 (2%) had their therapy escalated and deescalated in the non-DVT group, respectively (P < .001). Within the COVID-19 cohort, the D-dimer level was significantly greater in the DVT group at admission (2746 ng/mL vs 1481 ng/mL; P = .004) and at the duplex examination (6068 ng/mL vs 3049 ng/mL; P < .01). On multivariable analysis, male sex (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.06-4.87; P = .035), intensive care unit admission (OR, 3.42; 95% CI, 1.02-11.44; P = .046), and extracorporeal membrane oxygenation (OR, 5.5; 95% CI, 1.01-30.13; P = .049) were independently associated with DVT.ConclusionsGiven the high incidence of venous thromboembolic events in this population, we support the decision to empirically initiate therapeutic anticoagulation for patients with a low bleeding risk and severe COVID-19 infection. Duplex ultrasonography should be reserved for patients with a high clinical suspicion of venous thromboembolism for whom anticoagulation therapy could result in life-threatening consequences. Further study of patients with COVID-19 is warranted to elucidate the etiology of vascular thromboembolic events and guide the prophylactic and therapeutic interventions for these patients.

Dataset Information

Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke.

Publications

Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke.

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