Deep vein thrombosis: prevention in stroke patients during rehabilitation.

Deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) is a major source of mortality and morbidity in stroke patients. This study was designed to determine the effectiveness of different prophylactic treatments in the prevention of DVT after a stroke in patients undergoing rehabilitation. An additional objective was the identification of risk factors for DVT in stroke in patients during rehabilitation. Three hundred and sixty patients, over a 3-year period, were randomly assigned to one of four groups: adjusted dose heparin, intermittent pneumatic compression (IPC), functional electrical stimulation (FES), or control. There was no significant difference in the development of DVT by treatment group. Patients with DVT on admission (prevalent, n = 61) were compared with the study patients (n = 360). Time interval (from stroke to admission) and lactic dehydrogenase (LDH) concentration were significant risk factors, as well as predictors, for development of DVT (p < .000). These results suggest that the longer a patient remains without DVT prophylaxis after a stroke, the greater the risk of developing DVT and this supports early prophylaxis before rehabilitation.

Deep vein thrombosis in rehabilitating stroke patients. Incidence, risk factors and prophylaxis.

A total of 503 consecutive cases of suspected stroke were examined for potential eligibility based on recent development of a paralyzed limb. Of 123 otherwise eligible subjects, 22 were found by ultrasound to have deep vein thrombosis (DVT) on admission. Therefore, 101 patients were assigned randomly to one of the treatment groups or to the control group. The three treatments were adjusted-dose heparin, external pneumatic compression and functional electrical muscle stimulation. An ultrasound examination of the lower extremities was conducted twice a week on each patient until completion of the study (28 days or discharge, whichever came first). Electrical muscle stimulation was discontinued after 4 mo of the study because of discomfort, blister formation and high drop-out rate. Ten patients developed DVT during the study period. In 17 of the 32 cases of DVT, venography was performed, which confirmed the ultrasound findings in every case. The 32 cases of DVT differed from those without DVT by having a higher prevalence of hypertension (P = 0.02), cholesterol (P = 0.08) and a longer time interval between stroke and admission (P less than 0.05). We conclude that ultrasound is effective for DVT detection in the rehabilitation setting, and two-thirds of such cases are detectable on admission.