Background Without prophylaxis, about 50% of acute hemiplegic stroke patients developed deep vein thrombosis (DVT) within 2 weeks after onset of stroke and pulmonary embolism (PE) is responsible for up to 25% of early mortality among stroke patients in Caucasian. However, Asians were known to have relatively lower incidence of venous thromboembolism (VTE), which led to a wide practice variation in VTE prophylaxis among Asian countries. Unfortunately, only a few research is available for incidence of VTE among Asian stroke patients. Therefore, we investigated the incidence of VTE in Korean stroke patients.
Methods We prospectively enrolled patients with acute ischemic stroke admitted to our university hospital between May 2016 and Apr 2017. The inclusion criteria were; (1) aged ≥18 years with acute ischemic stroke diagnosed by neuroimaging, (2) admission within 7 days of symptom onset, (3) initial NIH Stroke Scale (NIHSS) of ≥1 for the lower limb affected by the stroke. Patients with prestroke modified Rankin Scale score ≥4 or with a past history of DVT were excluded. Doppler ultrasound scans of the lower limbs and plasma d-dimer assay were performed at days 7–14 and 15–28 after onset.
Results Of 285 patients admitted during the study period, 52 patients met inclusion criteria (mean age 74.5, male 59.6%, median initial NIHSS 12, and unable to walk unassisted at discharge 76.9%). Of 52 patients, all patients underwent the first Doppler study at days 7–14 and 46 patients (88.5%) underwent the second Doppler study at days 15–28. Plasma d-dimer level was available in all patients at the time of the first Doppler study, and in 35 patients (35/46, 76.1%) at the time of the second study. The level was above reference value (0.5 mg/L) in 40 patients at the first study (40/52, 76.9%), in 25 patients at second study (25/35, 71.4%). DVT at lower limbs was detected in 3 patients (5.8%) at the first Doppler study and in 2 patients (4.3%) at the second study. No patient was diagnosed as PE during the study period.
Conclusions The incidence of VTE was very low among Korean stroke patients. Plasma d-dimer assay was not helpful in evaluating VTE. Large-scale multicenter research should investigate the exact incidence of VTE in Asian stroke patients to provide safe and effective VTE prophylaxis.
Disclosures K. Ko: None. J. Choi: None.
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