Document Detail


Venous thromboembolism after acute ischemic stroke: a prospective study using magnetic resonance direct thrombus imaging.
MedLine Citation:
PMID:  15322298     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: We prospectively evaluated the prevalence and clinical risk factors for venous thromboembolism (VTE) after acute ischemic stroke using magnetic resonance direct thrombus imaging, a highly accurate noninvasive technique that directly visualizes thrombus.Method-102 unselected patients with AIS receiving standard prophylaxis with aspirin and graded compression stockings (GCS) were sequentially recruited, underwent regular clinical assessments, and were screened for VTE. RESULTS: The prevalence of all VTE, proximal deep vein thrombosis (PDVT), and pulmonary embolism (PE) after 21 days were 40%, 18%, and 12%, increasing to 63%, 30%, and 20% in patients with Barthel indices (BI) of < or =9 2 days after stroke (BI-2< or =9). Clinical deep vein thrombosis and PE occurred in 3% and 5% overall; half these events were overlooked by the attending team. The true incidence of clinical events is probably higher because the natural history of subclinical PDVT was modified by screening and anticoagulation. BI-2< or =9 or nonambulatory status 2 days after stroke were the clinical factors most strongly associated with subsequent VTE on univariate analysis. Odds ratios for any VTE and PDVT for BI-2< or =9 versus >9 were 8.3 (95% CI, 2.7 to 25.2) and 8.1 (95% CI, 1.7 to 38.3) on multivariable analysis. CONCLUSIONS: BI < or =9 or nonambulatory status around the time of admission identifies a subgroup of acute ischemic stroke patients at very high risk for VTE in whom the current strategy of thromboprophylaxis may be inadequate. Future thromboprophylactic studies should focus on the patients at high risk defined in this study.
Authors:
J Kelly; A Rudd; R R Lewis; C Coshall; A Moody; B J Hunt
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2004-08-19
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  35     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-09-24     Completed Date:  2005-03-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2320-5     Citation Subset:  IM    
Affiliation:
Department of Elderly Care, Guy's & St. Thomas' Hospital Trust, London, UK. jameskelly@northbrookfm.fsnet.co.uk
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MeSH Terms
Descriptor/Qualifier:
Aged
Aspirin / therapeutic use
Bandages
Female
Fibrinolytic Agents / therapeutic use
Humans
Magnetic Resonance Imaging
Male
Pulmonary Embolism / diagnosis,  epidemiology,  prevention & control
Risk Factors
Stroke / drug therapy,  physiopathology*
Thromboembolism / diagnosis,  epidemiology,  prevention & control
Venous Thrombosis / diagnosis,  epidemiology*,  prevention & control*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 50-78-2/Aspirin

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