Deep venous thrombosis after acute intracerebral hemorrhage☆
Introduction
There have been many reports describing the association of deep venous thrombosis (DVT) with stroke [1], [2], [3], [4]. Studies with I125 fibrinogen in patients with acute hemiplegic stroke have shown a DVT incidence of approximately 50% within two weeks in the absence of heparin prophylaxis [2]. DVT was found in 56% of patients with lower limb orthopedic or pelvic injury, and also in 40% of patients in whom the primary injury was neurotrauma [5]. It is well known that the risk of DVT in patients with acute ischemic stroke correlates with the degree of paralysis [6], and is greater in older patients [7] and those who have atrial fibrillation [8]. However, there is little data available on the incidence of DVT in patients with acute intracerebral hemorrhage (ICH), and there have been no reports about the clinical characteristics and risk factors for DVT in patients with acute ICH. Since the clinical trial of recombinant activated factor VII treatment for acute ICH has commenced, it is important to clarify the incidence and risk factors for the development of DVT. We evaluated the incidence of DVT and the characteristics of patients with acute ICH who developed DVT.
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Materials and methods
We prospectively studied patients admitted within 72 h of an acute spontaneous ICH between June 2005 and September 2006. The included patients did not have active cancer, surgery before admission, previous history or family history of venous thromboembolism. The patients had their National Institutes of Health and Stroke Scale (NIHSS) score [9] evaluated in the emergency room and underwent head computed tomography (CT) scan to diagnose acute ICH. All patients were given therapy for brain edema,
Results
Although 67 patients were admitted within 72 h of acute ICH, 15 were excluded because of disseminated intravascular coagulation or death within two weeks. All of them died from ICH and none of them suffered from pulmonary embolism before death. We analyzed the remaining 52 patients (age 70.9 ± 10.1 year s, 25 men and 27 women). Hypertension, diabetes mellitus, hyperlipidemia, current smoking habit, and atrial fibrillation were recorded in 46 (88.5%), 12 (23.1%), 6 (11.5%), 4 (7.7%), and 9 (17.3%)
Discussion
The present study indicates that the occurrence of DVT in patients with acute ICH is associated with the neurological severity evaluated by NIHSS score and with the D-dimer value. The incidence of DVT seems especially high in patients with both NIHSS score over 14 and D-dimer value over 0.8 μg/ml.
It is well known that the incidence of DVT in patients with stroke and in postsurgical patients is high [10]. It has been reported that DVT occurs in 2% to 3% of patients with ischemic stroke receiving
Acknowledgment
This study was supported by the Clinical Research Foundation (2006). The authors thank Ms. Masumi Inaba for her technical assistance.
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Financial disclosure statement: This study was supported 500,000 yen from the Clinical Research Foundation (2006). All authors were not supported by the sponsor corporate.