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Fu H, Hou D, Xu R, You Q, Li H, Yang Q, Wang H, Gao J, Bai D. Risk prediction models for deep venous thrombosis in patients with acute stroke: A systematic review and meta-analysis. Int J Nurs Stud 2024; 149:104623. [PMID: 37944356 DOI: 10.1016/j.ijnurstu.2023.104623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The number of risk prediction models for deep venous thrombosis (DVT) in patients with acute stroke is increasing, while the quality and applicability of these models in clinical practice and future research remain unknown. OBJECTIVE To systematically review published studies on risk prediction models for DVT in patients with acute stroke. DESIGN Systematic review and meta-analysis of observational studies. METHODS China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), SinoMed, PubMed, Web of Science, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Embase were searched from inception to November 7, 2022. Data from selected studies were extracted, including study design, data source, outcome definition, sample size, predictors, model development and performance. The Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist was used to assess the risk of bias and applicability. RESULTS A total of 940 studies were retrieved, and after the selection process, nine prediction models from nine studies were included in this review. All studies utilized logistic regression to establish DVT risk prediction models. The incidence of DVT in patients with acute stroke ranged from 0.4 % to 28 %. The most frequently used predictors were D-dimer and age. The reported area under the curve (AUC) ranged from 0.70 to 0.912. All studies were found to have a high risk of bias, primarily due to inappropriate data sources and poor reporting of the analysis domain. The pooled AUC value of the five validated models was 0.76 (95 % confidence interval: 0.70-0.81), indicating a fair level of discrimination. CONCLUSION Although the included studies reported a certain level of discrimination in the prediction models of DVT in patients with acute stroke, all of them were found to have a high risk of bias according to the PROBAST checklist. Future studies should focus on developing new models with larger samples, rigorous study designs, and multicenter external validation. REGISTRATION The protocol for this study is registered with PROSPERO (registration number: CRD42022370287).
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Affiliation(s)
- Han Fu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongjiang Hou
- College of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ran Xu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian You
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hang Li
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qing Yang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hao Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Gao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Dingxi Bai
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Han L, Yang JM, Qian WY, Xu XP, Tung TH, Liu Y, Wang F. Risk factors for lower extremity deep vein thrombosis in acute stroke patients following endovascular thrombectomy: a retrospective cohort study. Front Neurol 2023; 14:1249365. [PMID: 37885483 PMCID: PMC10599242 DOI: 10.3389/fneur.2023.1249365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/19/2023] [Indexed: 10/28/2023] Open
Abstract
Background Deep vein thrombosis (DVT) in lower extremities as a common complication of acute ischemic stroke (AIS) has long been studied. However, as the therapeutic options for AIS continue to advance, the pathogenic mechanisms behind DVT may change. Endovascular thrombectomy (EVT) has replaced intravenous thrombolysis and become the preferred treatment for AIS patients with large vessel occlusions. Therefore, it is important to update our understanding of DVT and its management. This study aimed to determine the prevalence and risk factors of DVT in AIS patients following EVT. Methods In this retrospective study, 245 AIS patients who had received EVT were recruited between January 2020 and December 2021. Within 10 days (median 4 days) of thrombectomy, DVT was diagnosed by ultrasonography. Demographic characteristics, clinical findings, and therapeutic procedures were compared between patients with and without DVT using univariate analysis. Cutoff points were defined for EVT time and plasma D-dimer concentration. Multivariable logistic regression was then used to determine the independent risk factors for DVT and evaluate their predictive power. Results The prevalence of DVT in AIS patients after EVT was 27.3%. Multifactorial logistic regression analysis showed that age (OR 1.036, 95% CI 1.001-1.073; P = 0.045), female sex (OR 3.015, 95% CI 1.446-6.289; P = 0.003), lower limb muscle strength less than grade three (OR 7.015, 95% CI 1.887-26.080; P = 0.004), longer EVT time (OR 1.012, 95% CI 1.004-1.020; P = 0.003), and higher D-dimer levels (OR 1.350, 95% CI 1.150-1.585; P < 0.001) were independently associated with higher DVT risk in AIS patients following EVT. The cutoff points for operative time of EVT and plasma D-dimer were 65.5 min and 1.62 mg/L, respectively, above which the risk for DVT was dramatically increased with OR > 4 in AIS patients. Conclusion AIS patients are at increased risk of developing DVT following EVT particularly if they have undergone prolonged thrombectomy procedures and exhibit high plasma levels of D-dimers. However, the results of our study need to be validated by a multicenter prospective study with a larger population of stroke patients.
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Affiliation(s)
- Li Han
- Department of Neurology, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jian-Miao Yang
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Wei-Yang Qian
- Department of Neurosurgery, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Xiao-Ping Xu
- Department of Neurology, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yang Liu
- Department of Neurology, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
- Department of Neurology, Saarland University, Homburg, Germany
| | - Feng Wang
- Department of Neurology, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
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Qin Y, Zhang B, Zhao S, Wang W, Dong S, Miao Y, Zhao S, Liu L, Wu Z, Kang J, Liu A. Association between higher systemic immune inflammation index (SII) and deep vein thrombosis (DVT) in patients with aneurysmal subarachnoid hemorrhage (aSAH) after endovascular treatment. Neurosurg Rev 2023; 46:142. [PMID: 37338601 DOI: 10.1007/s10143-023-02048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/21/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023]
Abstract
Inflammation contributes to deep vein thrombosis (DVT) formation in patients with aSAH after endovascular treatment. The relationship between systemic immune-inflammatory index (SII) as an inflammatory marker and DVT formation remains unclear. Thus, this study aims to evaluate the association between SII and aSAH-associated DVT following endovascular treatment. We enrolled 562 consecutive patients with aSAH after endovascular treatment at three centers from January 2019 to September 2021. The endovascular treatments included simple coil embolization and stent-assisted coil embolization. Deep venous thrombosis (DVT) was assessed by Color Doppler ultrasonography (CDUS). Multivariate logistic regression analysis was used to establish the model. We assessed the association of the SII, neutrophil-to-lymphocyte ratio (NLR), the systemic inflammatory response index (SIRI), platelet-lymphocyte ratio (PLR), and DVT by using restricted cubic spline (RCS). ASAH-associated DVT was found in 136 (24.20%) patients. Based on the multiple logistic regression analysis, the correlation was found between aSAH-associated DVT and elevated SII (fourth quartile) (adjusted odds ratio = 8.20 [95% confidence interval, 3.76-17.92]; p < 0.001 [p for trend < 0.001]), elevated NLR (fourth quartile) (adjusted odds ratio = 6.94 [95% confidence interval, 3.24-14.89]; p < 0.001 [p for trend < 0.001]), elevated SIRI (fourth quartile) (adjusted odds ratio = 4.82 [95% confidence interval, 2.36-9.84]; p < 0.001 [p for trend < 0.001]), and elevated PLR (fourth quartile) (adjusted odds ratio = 5.49 [95% confidence interval, 2.61-11.57]; p < 0.001 [p for trend < 0.001]). The increased SII was correlated with the formation of aSAH-associated DVT after endovascular treatment.
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Affiliation(s)
- Yongkai Qin
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Baorui Zhang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Shangfeng Zhao
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Wei Wang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Siyuan Dong
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yan Miao
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Songfeng Zhao
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Lang Liu
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Zhongxue Wu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Jun Kang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| | - Aihua Liu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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Tøndel BG, Morelli VM, Hansen J, Brækkan SK. Risk factors and predictors for venous thromboembolism in people with ischemic stroke: A systematic review. J Thromb Haemost 2022; 20:2173-2186. [PMID: 35815351 PMCID: PMC9796787 DOI: 10.1111/jth.15813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 01/07/2023]
Abstract
Identification of individuals with ischemic stroke at particularly high risk of venous thromboembolism (VTE) is crucial for targeted thromboprophylaxis. To guide clinical decision-making and development of risk prediction models, increased knowledge on risk factors and biomarkers is needed. Therefore, we set out to identify risk factors and predictors for VTE in people with ischemic stroke by conducting a systematic review of the literature. Medline and Embase were searched from January 1990 and onwards. Studies investigating demographic, clinical, and/or laboratory factors for stroke-related VTE were considered. Two reviewers screened all retrieved records, independently and in duplicate. Risk of bias assessments were guided by a structured framework (PROSPERO-ID: CRD42020176361). Of 4674 identified records, 26 studies were included. Twenty-six demographic, clinical, and laboratory factors associated with increased risk of stroke-related VTE after multivariable adjustments were identified. The following factors were reported by ≥2 studies: prior VTE, cancer, prestroke disability, leg weakness, increasing lesion volume of the brain infarct, infection, low Barthel Index, increasing length of hospital stay, biochemical indices of dehydration, as well as elevated levels of D-dimer, C-reactive protein, and homocysteine. The majority of the studies were of poor quality with moderate or high risk of bias. In conclusion, this systematic review informs on several potential risk factors and predictors for VTE in people with ischemic stroke. To improve risk stratification and guide development of risk prediction models, further confirmation is needed because there were few high-quality studies on each factor.
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Affiliation(s)
- Birgitte G. Tøndel
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
| | - Vânia M. Morelli
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - John‐Bjarne Hansen
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Sigrid K. Brækkan
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
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Li G, Wang C, Wang S, Hao Y, Xiong Y, Zhao X. Clinical Significance and Dynamic Change of Coagulation Parameters in Ischemic Stroke Patients Treated with Intravenous Thrombolysis. Clin Appl Thromb Hemost 2022; 28:10760296221121287. [PMID: 36040718 PMCID: PMC9434657 DOI: 10.1177/10760296221121287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective Investigations on coagulation parameters including fibrinogen (Fbg),
fibrinogen degradation products (FDP), and D-dimer in ischemic stroke
patients treated with intravenous thrombolysis are insufficient. We aimed to
investigate the association between in-hospital clinical outcomes and the
coagulation parameters at different time points in ischemic stroke patients
treated with intravenous tissues plasminogen activator (IV tPA). Methods We retrospectively enrolled patients who received IV tPA therapy within 4.5 h
from symptoms onset. Demographics, clinical characteristics, imaging
measures, and the discharge mRS score were collected. Multivariable logistic
regression analyses were performed to test whether coagulation parameters
were independent predictors for the in-hospital clinical outcomes. We also
employed machine learning models to investigate whether coagulation
parameters were able to improve the prediction of favorable functional
outcomes. Results One hundred and fifty-two patients treated with IV tPA were included. Among
the coagulation parameters, low D-dimers at 48 h proved to be an independent
predictor of favorable functional outcome (adjusted odd ratio 0.24, 95%
confidential intervals 0.06-0.92, P = 0.04). The AUC of D-dimer at 48 h to
predict favorable functional outcome was 0.73 (0.60-0.87) and the optimal
cut-off value was 0.92 (sensitivity 0.69, specificity 0.78). Machine
learning models with D-dimer at 48 h had superior performance in predicting
favorable functional outcomes and among the input variables in the machine
learning models, D-dimer at 48 h showed the highest weight in predicting mRS
0-1 at discharge (38.44%). Conclusion Increased levels of D-dimer at 48 h was associated with lower proportion of
favorable functional outcomes in acute ischemic stroke patients with
intravenous thrombolysis.
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Affiliation(s)
- Guangshuo Li
- Department of Neurology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuanying Wang
- Department of Neurology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shang Wang
- Department of Neurology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yahui Hao
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yunyun Xiong
- Department of Neurology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Chinese Institute for Brain Research, China
| | - Xingquan Zhao
- Department of Neurology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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6
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Pan X, Wang Z, Fang Q, Li T, Xu L, Deng S. A nomogram based on easily obtainable parameters for distal deep venous thrombosis in patients after acute stroke. Clin Neurol Neurosurg 2021; 205:106638. [PMID: 33930795 DOI: 10.1016/j.clineuro.2021.106638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/19/2021] [Accepted: 04/07/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To develop and validate a nomogram to predict the probability of distal deep venous thrombosis (DVT) within first 14 days of stroke onset in patients by using easily obtainable parameters. METHODS This is a retrospective study. The presence of distal DVT was evaluated using ultrasonography within the first 14 days. Data were randomly assigned to either a modelling data set or a validation data set. Univariable and multivariate logistic regression analysis was used to determine risk scores to predict distal DVT in the modelling data set, and nomogram and calibration curve were constructed by R project. RESULTS A total of 1620 patients with acute stroke were enrolled in the study. The multivariate analysis revealed that the old age, female gender, haemorrhagic stroke, coronary heart disease, lower limb weakness, a low serum albumin level, and a high D-dimer level are highly predictive of 14-day risk of distal DVT. The AUC of the nomogram to predict the 14-day risk of distal DVT was 0.785 (95% CI, 0.742-0.827) and 0.813 (0.766-0.860) for the modelling cohort and external validation cohort, respectively. Moreover, the calibration of the nomogram showed a nonsignificant Hosmer-Lemeshow test statistic in the modelling (P = 0.876) and validation (P = 0.802) sets. With respect to decision curve analyses, the nomogram exhibited preferable net benefit gains than the staging system across a wide range of threshold probabilities. CONCLUSION The established nomogram displayed a superior performance in terms of predictive accuracy, discrimination capability, and clinical utility, may be helpful for clinicians to identify high-risk groups of distal DVT.
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Affiliation(s)
- Xi Pan
- Departments of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Zhi Wang
- Departments of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Qi Fang
- Departments of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Tan Li
- Departments of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Lan Xu
- Nursing department, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Shengming Deng
- Department of Nuclear Medicine, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Development and Validation of a Nomogram for Lower Extremity Deep Venous Thrombosis in Patients after Acute Stroke. J Stroke Cerebrovasc Dis 2021; 30:105683. [PMID: 33676327 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105683] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/27/2021] [Accepted: 02/12/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To develope and validate a nomogram to predict the probability of deep venous thrombosis (DVT) in patients after acute stroke during the first 14 days with clinical features and easily obtainable biochemical parameters. METHODS This is a single-center prospective cohort study. The potential predictive variables for DVT at baseline were collected, and the presence of DVT was evaluated using ultrasonography within the first 14 days. Data were randomly assigned to either a modeling data set or a validation data set. Univariable and Multivariate logistic regression analysis was used to develop risk scores to predict DVT in the modeling data set and the area under the receiver operating characteristic curve to validate the score in the test data set, and nomogram and calibration curve were constructed by R project. RESULTS A total of 1651 patients with acute stroke were enrolled in the study. The overall incidence of DVT after acute stroke within two weeks was 14.4%. Multivariable analysis detected older age (≥65 years),female gender, hemorrhagic stroke, malignancy, lower limb muscle strength<3 grade, Albumin<40 g·L-1 and D-dimer>0.5 mg·L-1 were highly predictive of 14-day risk of DVT. The AUC of the nomogram with these above-mentioned independent risk factors to predict the 14-day risk of DVT was 0.756 (95% CI, 0.712-0.812) and 0.811 (95%CI, 0.762-0.859) for the modeling cohort and external validation cohort, respectively. Moreover, the calibration of the nomogram showed a nonsignificant Hosmer-Lemeshow test statistic in the modeling (P = 0.250) and validation sets (P = 0.995). With respect to decision curve analyses, the nomogram exhibited preferable net benefit gains than the staging system across a wide range of threshold probabilities. CONCLUSION This nomogram had a good performance in predictive accuracy, discrimination capability, and clinical utility, which was helpful for clinicians to identify high-risk groups of DVT and formulate relevant prevention and treatment measures.
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Ha SH, Kim YJ, Heo SH, Chang DI, Kim BJ. Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke. BMC Neurol 2020; 20:257. [PMID: 32593290 PMCID: PMC7320547 DOI: 10.1186/s12883-020-01842-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/24/2020] [Indexed: 01/10/2023] Open
Abstract
Background Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke. Methods Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Clinical characteristics and laboratory results, including D-dimer level, were compared between patients with and without DVT. Independent risk factors for DVT were investigated using multivariable analysis. Similar analysis was performed to identify factors associated with elevated D-dimer level (> 0.5 mg/dl) in acute ischemic stroke patients. Results During the study period, 289 patients were enrolled, and 38 (13.1%) showed DVT. Female sex (OR = 2.579, 95% CI = 1.224–5.432; p = 0.013) and a high National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.191 95% CI = 1.095–1.294; p = 0.005) were independently associated with the presence of DVT, although D-dimer level was not. Stroke mechanism, especially cardioembolic stroke (OR = 3.777, 95% CI = 1.532–9.313; p = 0.004; reference: large artery atherosclerosis), NIHSS score (OR = 1.087, 95% CI = 1.002–1.179; p = 0.001) and thrombolysis (OR = 12.360, 95% CI 2.456–62.213; p = 0.002) were independently associated with elevated abnormal D-dimer levels. Conclusion The severity of ischemic stroke, but not the D-dimer level, was associated with the presence of DVT in Asian ischemic stroke patients. D-dimer level was influenced by the stroke mechanism. LEUS in patients with severe neurological deficit, rather than screening with D-dimer, may be more beneficial for diagnosing DVT in Asian patients with acute ischemic stroke.
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Affiliation(s)
- Sang Hee Ha
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Yeon-Jung Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpagu, Seoul, 138-736, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpagu, Seoul, 138-736, Republic of Korea.
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Takeshima M, Ishikawa H, Umeta Y, Kudoh M, Umakoshi A, Yoshizawa K, Ito Y, Hosoya T, Tsutsui K, Ohta H, Mishima K. Prevalence of Asymptomatic Venous Thromboembolism in Depressive Inpatients. Neuropsychiatr Dis Treat 2020; 16:579-587. [PMID: 32161463 PMCID: PMC7049756 DOI: 10.2147/ndt.s243308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/20/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE While depression has been recognized as a risk factor for venous thromboembolism (VTE), the prevalence of VTE in depressed inpatients has never been investigated. The aim of this study was thus to examine VTE prevalence and factors associated with VTE in depressed inpatients. PATIENTS AND METHODS We conducted a retrospective cross-sectional study of consecutive depressed inpatients (n = 94) from January 1, 2018, to June 30, 2019, at the psychiatry department of Akita University Hospital. As part of our clinical routine, depressed inpatients were screened for VTE using D-dimer, and patients who screened positive underwent enhanced CT to examine VTE. A variety of data was extracted from medical records, including, amongst others, age, sex, body mass index, diagnoses of psychiatric disorders, total scores on the 17-item Hamilton Depression Rating Scale, duration of current depressive episode, daily dosages of antidepressants and antipsychotics, catatonia, and physical restraint. RESULTS VTE was detected in 8.5% of depressed inpatients. There were no significant differences between VTE-positive and VTE-negative inpatients regarding any of the considered factors. CONCLUSION Our analysis shows a VTE prevalence of 8.5% in depressed inpatients, higher than that of 2.3% reported in a previous study in hospitalized patients with psychiatric disorders including depression. This emphasizes the importance of VTE screening for depressive inpatients.
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Affiliation(s)
- Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Hiroyasu Ishikawa
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Yoshiaki Umeta
- Department of Psychiatry, Omagari City Hospital, Akita 014-0067, Japan
| | - Mizuki Kudoh
- Department of Neuropsychiatry, Nakadori Rehabilitation Hospital, Akita 010-0001, Japan
| | - Akise Umakoshi
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | | | - Yu Ito
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Tomoko Hosoya
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Ko Tsutsui
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Hidenobu Ohta
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
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Karsy M, Azab MA, Harper J, Abou-Al-Shaar H, Guan J, Eli I, Brock AA, Ormond RD, Hosokawa PW, Gouripeddi R, Butcher R, Cole CD, Menacho ST, Couldwell WT. Evaluation of a D-Dimer Protocol for Detection of Venous Thromboembolism. World Neurosurg 2019; 133:e774-e783. [PMID: 31605841 DOI: 10.1016/j.wneu.2019.09.160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of venous duplex ultrasonography (VDU) for confirmation of deep venous thrombosis in neurosurgical patients is costly and requires experienced personnel. We evaluated a protocol using D-dimer levels to screen for venous thromboembolism (VTE), defined as deep venous thrombosis and asymptomatic pulmonary embolism. METHODS We used a retrospective bioinformatics analysis to identify neurosurgical inpatients who had undergone a protocol assessing the serum D-dimer levels and had undergone a VDU study to evaluate for the presence of VTE from March 2008 through July 2017. The clinical risk factors and D-dimer levels were evaluated for the prediction of VTE. RESULTS In the 1918 patient encounters identified, the overall VTE detection rate was 28.7%. Using a receiver operating characteristic curve, an area under the curve of 0.58 was identified for all D-dimer values (P = 0.0001). A D-dimer level of ≥2.5 μg/mL on admission conferred a 30% greater relative risk of VTE (sensitivity, 0.43; specificity, 0.67; positive predictive value, 0.27; negative predictive value, 0.8). A D-dimer value of ≥3.5 μg/mL during hospitalization yielded a 28% greater relative risk of VTE (sensitivity, 0.73; specificity, 0.32; positive predictive value, 0.24; negative predictive value, 0.81). Multivariable logistic regression showed that age, male sex, length of stay, tumor or other neurological disease diagnosis, and D-dimer level ≥3.5 μg/mL during hospitalization were independent predictors of VTE. CONCLUSIONS The D-dimer protocol was beneficial in identifying VTE in a heterogeneous group of neurosurgical patients by prompting VDU evaluation for patients with a D-dimer values of ≥3.5 μg/mL during hospitalization. Refinement of this screening model is necessary to improve the identification of VTE in a practical and cost-effective manner.
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Affiliation(s)
- Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Mohammed A Azab
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan Harper
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA; Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, New York, USA
| | - Jian Guan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Ilyas Eli
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Andrea A Brock
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Ryan D Ormond
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA
| | - Patrick W Hosokawa
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado, USA
| | | | - Ryan Butcher
- Department of Bioinformatics, University of Utah, Salt Lake City, Utah, USA
| | - Chad D Cole
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA
| | - Sarah T Menacho
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
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11
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Diagnostic accuracy of biomarker D-dimer in patients after stroke suspected from venous thromboembolism: A diagnostic meta-analysis. Clin Biochem 2019; 63:126-134. [DOI: 10.1016/j.clinbiochem.2018.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/06/2018] [Accepted: 09/23/2018] [Indexed: 01/10/2023]
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12
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Ko KH, Kang JH, Kang SY, Lee JS, Song SK, Oh JH, Kim JG, Han EY, Lee HK, Choi JC. Venous Thromboembolism Following Acute Ischemic Stroke: A Prospective Incidence Study. JOURNAL OF NEUROCRITICAL CARE 2018. [DOI: 10.18700/jnc.180068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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13
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Kim JY, Im S, Choi YM, Jang YJ, Chae CS, Park GY. Relationship Between Deep Vein Thrombosis and Lower Limb Swelling in Patients with Brain Lesions. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ju Yong Kim
- Medical Corps of 21st Division, Republic of Korea Army, Yanggu, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Yong Min Choi
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Jun Jang
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
| | - Choong Sik Chae
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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14
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Matsuo H, Nakajima Y, Ogawa T, Mo M, Tazaki J, Doi T, Yamada N, Suzuki T, Nakajima H. Evaluation of D-Dimer in Screening Deep Vein Thrombosis in Hospitalized Japanese Patients with Acute Medical Diseases/Episodes. Ann Vasc Dis 2016; 9:193-200. [PMID: 27738461 DOI: 10.3400/avd.oa.16-00034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/22/2016] [Indexed: 01/09/2023] Open
Abstract
Objective: To investigate the usefulness of D-dimer as a screening method as well as to explore potent predictors of deep vein thrombosis (DVT) in hospitalized Japanese patients with acute medical diseases/episodes. Methods and Subjects: This study was a multi-center, prospective, observational study. The inclusion criteria were hospitalized patients at high risk of developing venous thromboembolism with; (1) congestive heart failure, acute exacerbation of chronic obstructive pulmonary disease, infectious diseases, or inflammatory diseases, (2) bed rest ≥4 days, and (3) ≥60 years old. D-dimer was measured on the same day as ultrasonography. Multivariate logistic regression analysis was performed to investigate predictors associated with the presence of DVT. Results: Sixty-nine patients were enrolled. The prevalence of DVT was 33.3% (23/69; 95% C.I., 19.4% to 47.3%). D-dimer was measured in 42 patients and the sensitivity and negative predictive value reached 100%, while the specificity (13.3%) and positive predictive value (31.6%) were low (cut-off value: 0.9 or 1.0 µg/mL). Statistically significant predictor was not assigned. Conclusion: As the sensitivity and negative predictive value of D-dimer reached 100%, D-dimer have a role in excluding patients who might otherwise undergo diagnostic imaging for DVT in hospitalized Japanese patients with acute medical diseases/episodes.
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Affiliation(s)
- Hiroshi Matsuo
- Matsuo Vascular Ultrasound Laboratory, Matsuo Clinic, Suita, Osaka, Japan
| | - Yoshie Nakajima
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomohiro Ogawa
- Cardiovascular Disease Center, Fukushima Daiichi Hospital, Fukushima, Fukushima, Japan
| | - Makoto Mo
- Department of Cardiovascular Surgery, Yokohama Minami Kyousai Hospital, Yokohama, Kanagawa, Japan
| | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Takahiro Doi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Norikazu Yamada
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Takeo Suzuki
- Development & Medical Affairs Division, GlaxoSmithKline K.K., Shibuya, Tokyo, Japan
| | - Hiromu Nakajima
- Development & Medical Affairs Division, GlaxoSmithKline K.K., Shibuya, Tokyo, Japan
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15
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Kato A, Ikeda T, Kono T, Morishima H, Nagashima G. Systemic thromboembolism presenting as vertebral artery occlusion caused by patent foramen ovale with low D-dimer elevation. ACTA ACUST UNITED AC 2016. [DOI: 10.3918/jsicm.23.660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Akihito Kato
- Center of Emergency and Disaster Medicine, Kawasaki Municipal Tama Hospital
| | - Tetsuya Ikeda
- Department of Neurosurgery, Kawasaki Municipal Tama Hospital
| | - Takao Kono
- Department of Neurosurgery, Kawasaki Municipal Tama Hospital
| | | | - Goro Nagashima
- Center of Emergency and Disaster Medicine, Kawasaki Municipal Tama Hospital
- Department of Neurosurgery, Kawasaki Municipal Tama Hospital
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16
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Cheng X, Zhang L, Xie NC, Ma YQ, Lian YJ. High Plasma Levels of D-Dimer Are Independently Associated with a Heightened Risk of Deep Vein Thrombosis in Patients with Intracerebral Hemorrhage. Mol Neurobiol 2015; 53:5671-8. [PMID: 26491025 DOI: 10.1007/s12035-015-9487-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/12/2015] [Indexed: 11/26/2022]
Abstract
Deep venous thrombosis (DVT) is a complication of stroke. Our aim was to determine whether D-dimer plasma levels at admission could be a risk factor for DVT in Chinese patients with acute intracerebral hemorrhage (ICH). From December 2012 to November 2014, all patients with first-ever acute ICH were included. At baseline, the demographical and clinical data were taken. These patients were assessed for DVT using color Doppler ultrasonography (CDUS) on 15 days after ICH and whenever clinically requested. Multivariate analyses were performed using logistic regression models. Receiver operating characteristic (ROC) curves were used to test the overall predictive accuracy of D-dimer and other markers. In our study, acute ICH was diagnosed in 265 patients and 210 completed a 15-day follow-up and were included in the analysis. Fifty-four (25.7 %) out of the 210 patients were diagnosed as DVT. Plasma D-dimer levels were significantly higher in ICH patients with DVT as compared to those without DVT (P < 0.0001). Multivariate logistic regression analysis adjusted for common risk factors showed that plasma D-dimer levels ≥1.20 mg/L were an independent predictor of DVT [odds ratio (OR) = 12.99, 95 % confidence interval (CI) = 3.17-32.98; P < 0.0001]. With an area under the curve (AUC) of 0.91 (95 % CI = 0.86-0.94), D-dimer showed a significantly greater discriminatory ability to predict DVT as compared with high-sensitivity C-reactive protein (Hs-CRP) (AUC = 0.77, 95 % CI = 0.70-0.82; P < 0.01), homocysteine (HCY) (AUC = 0.75, 95 % CI = 0.70-0.81; P < 0.01), and National Institutes of Health Stroke Scale (NIHSS) score (AUC = 0.80, 95 % CI = 0.72-0.85; P < 0.01). The present study suggested that elevated D-dimer plasma levels were independent predictors for DVT in Chinese patients with ICH.
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Affiliation(s)
- Xuan Cheng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi Area, Zhengzhou, 450000, Henan Province, People's Republic of China
| | - Lu Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi Area, Zhengzhou, 450000, Henan Province, People's Republic of China
| | - Nan-Chang Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi Area, Zhengzhou, 450000, Henan Province, People's Republic of China
| | - Yun-Qing Ma
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi Area, Zhengzhou, 450000, Henan Province, People's Republic of China
| | - Ya-Jun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi Area, Zhengzhou, 450000, Henan Province, People's Republic of China.
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17
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Yamada N, Hanzawa K, Ota S, Nakamura M, Sato K, Ikura M, Suzuki T, Kaise T, Nakajima H, Ito M. Occurrence of Deep Vein Thrombosis among Hospitalized Non-Surgical Japanese Patients. Ann Vasc Dis 2015; 8:203-9. [PMID: 26421068 DOI: 10.3400/avd.oa.14-00132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 05/21/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the frequency of deep vein thrombosis (DVT) among non-surgical inpatients, and to evaluate the D-dimer assay as a screening tool for DVT. METHODS Subjects were non-surgical inpatients aged 20 years or older who had been bedridden for at least 24 hours and had moderate-to-high risk factors for DVT. We assessed the presence of DVT by venous ultrasonography. Patients who received a diagnosis of venous thromboembolism (VTE) before admission, who had symptoms or findings of VTE at admission, or who had surgery or trauma within the past 3 months before admission were excluded. RESULTS DVT was confirmed in 96 of 525 patients (18.3%). In a logistic regression analysis, longer duration of hospitalization, higher D-dimer value, and history of cancer surgery were significantly associated with the occurrence of DVT. The D-dimer assay showed high sensitivity (96.1%) and high negative predictive value (97.6%). CONCLUSION Non-surgical inpatients with a long-term hospitalization or history of cancer surgery have a risk for DVT, and need to be considered for added DVT preventive measures as recommended in the prevention guidelines. In addition, the D-dimer assay is beneficial for the screening of DVT in medical practice.
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Affiliation(s)
- Norikazu Yamada
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kazuhiko Hanzawa
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan
| | - Satoshi Ota
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Mashio Nakamura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Koichi Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan
| | - Maiko Ikura
- Department of Internal Medicine, Niigata National Hospital, National Hospital Organization, Kashiwazaki, Niigata, Japan
| | - Takeo Suzuki
- Development & Medical Affairs Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Toshihiko Kaise
- Development & Medical Affairs Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Hiromu Nakajima
- Development & Medical Affairs Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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18
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Gutiérrez-Fernández M, Fuentes B, Rodríguez-Frutos B, Ramos-Cejudo J, Otero-Ortega L, Díez-Tejedor E. Different protective and reparative effects of olmesartan in stroke according to time of administration and withdrawal. J Neurosci Res 2014; 93:806-14. [PMID: 25524827 DOI: 10.1002/jnr.23532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 11/05/2014] [Accepted: 11/05/2014] [Indexed: 01/01/2023]
Abstract
Angiotensin type 1 receptor blockers (ARBs) have induced improved functional recovery and reduced infarct volume in experimental animal models of stroke. Clinical data have indicated a positive correlation between prestroke treatment with ARBs and reduced stroke severity and better outcomes; however, the mechanisms of these beneficial effects are not yet well understood. This study compares the protective and possible reparative effects of continuous oral treatment with olmesartan (OLM) with OLM pretreatment and withdrawal after permanent middle cerebral artery occlusion (pMCAO) in rats. Fifty-two Sprague-Dawley rats were randomly assigned to five groups: MCAO(-/OLM) (OLM 10 mg/kg/day for 14 days after infarct), MCAO(OLM/OLM) (OLM 10 mg/kg/day for 7 days before and 14 days after infarct), MCAO(OLM/-) (OLM 10 mg/kg/day for 7 days before infarct), sham, and control. We analyzed functional recovery; lesion size; cell death; expression of the pro-oxidant enzyme NADPH oxidase 4 (NOX-4); isolectin-B4; and repair markers such as glial fibrillary acidic protein, vascular endothelial growth factor (VEGF), and brain-derived neurotrophic factor (BDNF). All of the OLM-treated groups showed significantly better functional scores and reduced infarct sizes and cell death compared with the control group 14 days after pMCAO. Levels of NOX-4, VEGF, and BDNF were significantly lower in the brains of the MCAO(OLM/OLM) and sham groups compared with the other groups. OLM treatment improved functional recovery and reduced lesion size and cell death after cerebral ischemia. Only the continuous administration of OLM before and after stroke reduced oxidative stress levels, with better tissue preservation, without triggering brain repair marker activation.
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Affiliation(s)
- María Gutiérrez-Fernández
- Department of Neurology and Stroke Centre, Neuroscience and Cerebrovascular Research Laboratory, La Paz University Hospital, Neuroscience Area of IdiPAZ (Health Research Institute), Autónoma University of Madrid, Madrid, Spain
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19
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Liu L, Zheng H, Wang DZ, Wang Y, Hussain M, Sun H, Wang A, Zhao X, Dong K, Wang C, He W, Ning B, Wang Y. Risk assessment of deep-vein thrombosis after acute stroke: a prospective study using clinical factors. CNS Neurosci Ther 2014; 20:403-10. [PMID: 24612485 PMCID: PMC6493054 DOI: 10.1111/cns.12227] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/22/2013] [Accepted: 12/29/2013] [Indexed: 01/14/2023] Open
Abstract
AIMS Deep-vein thrombosis (DVT) represents a serious complication in acute stroke patients with pulmonary embolus (PE) as a potential outcome. Prediction of DVT may help with formulating a proper prevention strategy. To assess of the risk of deep venous thrombosis (DVT) in acute stroke patients, we developed and validated a clinical score in a cohort study. METHODS Incidence of Deep Venous Thrombosis after Acute Stroke in China (INVENT-China) is a multicenter prospective cohort study. The potential predictive variables for DVT at baseline were collected, and the presence of DVT was evaluated using ultrasonography on the 14 ± 3 days. Data were randomly assigned to either a training data set or a test data set. Multivariate logistic regression analysis was used to develop risk scores to predict DVT in the training data set and the area under the receiver operating characteristic curve to validate the score in the test data set. RESULTS From 2006-2007, 862 hospital-based acute stroke patients were enrolled in China. The overall incidence of DVT after acute stroke within two weeks was 12.4% (95%CI 10.3-14.7%). A seven-point score derived in the training data set (age [≥65 years = 1], sex [female gender = 1]), obesity [BMI ≥ 25 kg/m(2) = 1], active cancer [yes = 2], stroke subtype [cerebral hemorraghe = 1], muscle weakness [≥2 on Lower limb NIHSS score = 1] was highly predictive of 14-day risk of DVT(c statistic = 0.70, 95% CI, 0.64-0.76, P < 0.001), in the overall study population(c statistic = 0.65, 95% CI 0.59-0.70, P < 0.001). CONCLUSIONS This clinical score may help identify acute stroke patients with high risk of DVT. In addition, it also serves as a platform to develop further models of DVT prediction in stroke patients based on clinical factors.
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Affiliation(s)
- Li‐Ping Liu
- Department of Neurology Beijing Tiantan Hospital affiliated Capital Medical UniversityBeijingChina
| | - Hua‐Guang Zheng
- Department of Neurology Beijing Tiantan Hospital affiliated Capital Medical UniversityBeijingChina
| | - David. Z. Wang
- Department of Neurology OSF Healthcare Systems Illinois Neurological Institute Stroke Network University of Illinois College of Medicine at PeoriaPeoria ILUSA
| | - Yi‐Long Wang
- Department of Neurology Beijing Tiantan Hospital affiliated Capital Medical UniversityBeijingChina
| | | | - Hai‐Xin Sun
- Department of Neurology Beijing Tiantan Hospital affiliated Capital Medical UniversityBeijingChina
| | - An‐Xin Wang
- Department of Neurology Beijing Tiantan Hospital affiliated Capital Medical UniversityBeijingChina
| | - Xing‐Quan Zhao
- Department of Neurology Beijing Tiantan Hospital affiliated Capital Medical UniversityBeijingChina
| | - Ke‐Hui Dong
- Department of Neurology Beijing Tiantan Hospital affiliated Capital Medical UniversityBeijingChina
| | - Chun‐Xue Wang
- Department of Neurology Beijing Tiantan Hospital affiliated Capital Medical UniversityBeijingChina
| | - Wen He
- Department of UltrasoundBeijing Tiantan Hospital affiliated Capital Medical UniversityBeijingChina
| | - Bin Ning
- Department of UltrasoundBeijing Tiantan Hospital affiliated Capital Medical UniversityBeijingChina
| | - Yong‐Jun Wang
- Department of Neurology Beijing Tiantan Hospital affiliated Capital Medical UniversityBeijingChina
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Koracevic GP. Nine modalities to report d-dimer concentration: how many is too many? Am J Emerg Med 2012; 30:1007-8. [DOI: 10.1016/j.ajem.2012.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022] Open
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