Deep vein thrombosis based on D-dimer screening in ischaemic stroke patients undergoing rehabilitation.

INTRODUCTION: Although lower extremity deep vein thrombosis (DVT) is a common complication after an acute stroke, there is little local data documenting this condition in stroke patients undergoing rehabilitation. The purpose of this study was to determine the frequency and risk factors of DVT in ischaemic stroke patients admitted to a rehabilitation unit. METHODS: This was a prospective observational single-centre study of ischaemic stroke patients with lower limb paresis admitted to a rehabilitation centre. The screening protocol consisted of quantitative D-dimer assay (DDA) within 24-48 hours of rehabilitation admission followed by duplex Doppler ultrasonography (DUS) of the paretic lower extremity if the DDA level was elevated (equal or greater than 0.34 micro/ml). RESULTS: 212 patients (167 Chinese, 27 Malays, 17 Indians and one Eurasian) were screened at a mean of 23.2 days post-stroke. 121 (57.1 percent) patients had an elevated DDA, and all underwent ultrasonography. The incidence of lower limb DVT was 5.2 percent (11), consisting of four proximal and seven distal. DVT was significantly related to total anterior circulation infarct (odds ratio 3.69, 95 percent confidence interval 1.04-3.05, p-value is 0.043), but not to age, gender, race, severity of lower limb weakness, and ambulatory and functional status. No patients had clinical pulmonary embolism during rehabilitation. CONCLUSION: Locally, asymptomatic lower limb DVT based on a screening protocol of DDA and selective DUS, is uncommon in ischaemic stroke patients admitted to rehabilitation. Future research efforts could include a detailed evaluation of DDA's role as a screening tool for DVT in the stroke population, by comparing it to an established gold standard like venography.

Deep vein thrombosis in stroke patients admitted to a rehabilitation unit in Singapore.

BACKGROUND: Studies have shown that deep vein thrombosis (DVT) is common after an acute stroke. Less common are studies documenting DVT in stroke patients admitted to rehabilitation. The purpose of this study was to determine the frequency and risk factors of DVT in stroke patients admitted to a rehabilitation unit in Singapore. METHODS: A prospective observational single-center study of patients with ischemic and hemorrhagic stroke with lower limb paresis admitted to a rehabilitation center in Singapore. The screening protocol consisted of quantitative D-dimer assay (DDA) within 24-48 h of rehabilitation admission followed by duplex ultrasound scan of the paretic lower extremity if DDA level was elevated (equal or greater than 0.34 microg/ml). RESULTS: Altogether, 341 patients were screened at a mean of 23 days poststroke. One hundred and ninety-eight (58.1%) patients had an elevated DDA and all underwent ultrasound scans. The frequency of lower limb DVT was 9% (18) - seven proximal and 11 distal. DVT was significantly related to higher D-dimer levels (P=0.029) and cortical strokes (P=0.004), but not to age, gender, race, nature of stroke, atrial fibrillation, severity of lower limb weakness, and ambulatory and functional status. No patients had clinical pulmonary embolism during rehabilitation. CONCLUSIONS: Lower limb DVT is uncommon in stroke patients admitted to rehabilitation in Singapore. Future research should include evaluation of the cost-effectiveness of such a screening protocol.