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Liu L, Zhou J, Zhang Y, Lu J, Gan Z, Ye Q, Wu C, Xu G. A Nomogram for Individualized Prediction of Calf Muscular Vein Thrombosis in Stroke Patients During Rehabilitation: A Retrospective Study. Clin Appl Thromb Hemost 2022; 28:10760296221117991. [PMID: 35942697 PMCID: PMC9373120 DOI: 10.1177/10760296221117991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To develop a nomogram for predicting calf muscle veins thrombosis (CMVT) in stroke patients during rehabilitation. Methods: We enrolled 360 stroke patients from the Rehabilitation Medicine Center from December 2015 to February 2019. Of the participants, 123 were included in the CMVT group and 237 in the no CMVT group. The least absolute shrinkage and selection operator (LASSO) regression model was applied to optimize feature selection for the model. Multivariable logistic regression analysis was applied to construct a predictive model. Performance and clinical utility of the nomogram were generated using the Harrell's concordance index, calibration curve, and decision curve analysis (DCA). Results: Age, Brunnstrom stage (lower extremity), D-dimer, and antiplatelet therapy were associated with the occurrence of CMVT. The prediction nomogram showed satisfactory performance with a concordance index of 0.718 (95% CI: 0.663-0.773) in internal verification. The Hosmer-Lemeshow test, P = .217, suggested that the model was of goodness-of-fit. In addition, the DCA demonstrated that the CMVT nomogram had a good clinical net benefit. Conclusions: We developed a nomogram that could help clinicians identify high-risk groups of CMVT in stroke patients during rehabilitation for early intervention.
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Affiliation(s)
- Lingling Liu
- 74734School of Rehabilitation Medicine, Nanjing Medical University, Rehabilitation Medicine Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Juan Zhou
- 74734Department of Ultrasonography, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - YiQing Zhang
- 74734School of Rehabilitation Medicine, Nanjing Medical University, Rehabilitation Medicine Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Lu
- 74734School of Rehabilitation Medicine, Nanjing Medical University, Rehabilitation Medicine Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhaodan Gan
- 74734School of Rehabilitation Medicine, Nanjing Medical University, Rehabilitation Medicine Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Ye
- 74734School of Rehabilitation Medicine, Nanjing Medical University, Rehabilitation Medicine Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chuyan Wu
- 74734School of Rehabilitation Medicine, Nanjing Medical University, Rehabilitation Medicine Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guangxu Xu
- 74734School of Rehabilitation Medicine, Nanjing Medical University, Rehabilitation Medicine Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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2
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Zhu X, Cai X, Zhou X, Li Y, Yang C. Retinal vein occlusion with cerebral infarction in a preterm neonate: a case report. BMC Pediatr 2021; 21:511. [PMID: 34784915 PMCID: PMC8594150 DOI: 10.1186/s12887-021-02989-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retinal vein occlusion (RVO) is a common disease that causes blindness in elderly patients, and cerebral infarction is also a severe disorder impairing the health of individuals. Both diseases are not common in neonates and are related to thrombosis. To date, only one case of simultaneous occurrence of RVO with intracranial haemorrhage in a full-term neonate has been reported. CASE PRESENTATION A preterm neonate was diagnosed with cerebral infarction and RVO. Retinal haemorrhage and macular oedema were detected in the left eye after the onset of ipsilateral stroke. Although the retinal conditions in this case resolved spontaneously without ocular treatment, the long-term effect on visual function is still unknown. CONCLUSIONS Given that ocular fundus examinations are rarely performed in paediatric stroke patients, a screening fundus examination in these newborns with stroke might be worth considering.
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Affiliation(s)
- Xiuyu Zhu
- Department of Ophthalmology, Children's Hospital of Fudan University, National Children's Medical Center, Wanyuan Road No.399, Shanghai, 201102, China
| | - Xiaojing Cai
- Department of Ophthalmology, Children's Hospital of Fudan University, National Children's Medical Center, Wanyuan Road No.399, Shanghai, 201102, China
| | - Xiaohong Zhou
- Department of Ophthalmology, Children's Hospital of Fudan University, National Children's Medical Center, Wanyuan Road No.399, Shanghai, 201102, China
| | - Yian Li
- Department of Ophthalmology, Children's Hospital of Fudan University, National Children's Medical Center, Wanyuan Road No.399, Shanghai, 201102, China
| | - Chenhao Yang
- Department of Ophthalmology, Children's Hospital of Fudan University, National Children's Medical Center, Wanyuan Road No.399, Shanghai, 201102, China.
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Xiang X, Yuan D, Kong P, Chen T, Yao H, Lin S, Zhang X, Cao H. Deep vein thrombosis inhibitor may play a therapeutic role in post-stroke patients. BMC MEDICAL GENETICS 2020; 21:174. [PMID: 33092540 PMCID: PMC7579790 DOI: 10.1186/s12881-020-01108-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/13/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Deep vein thrombosis (DVT) is associated with stroke. Here, we hypothesize that genes associated with DVT may also play roles in the development of stroke. METHODS we firstly conducted large-scale literature based disease-gene relationship data analysis to explore the genes implicated with DVT and stroke. Further, a mega-analysis was conducted for each of these genes that were linked to DVT but not stroke, using 11 independent stroke RNA expression datasets (176 stroke cases and 102 healthy controls). Then, a multiple linear regression (MLR) model was employed to study possible influential factors on the gene expression levels in stroke. After that, a functional pathway analysis was performed to identify the potential biological linkage between stroke and the target genes suggested by mega-analysis. RESULTS Over 81.10% genes implicated with DVT also suggested an association with stroke. Among the 24 DVT-specific genes, one DVT-inhibiting gene, SP1, presented significantly increased expression in stroke (LFC = 1.34, p-value = 0.0045). Pathway analysis showed that SP1 may play a therapeutic role in post-stroke patients by promoting multiple of stroke-inhibitors. Moreover, geographical region was indicated as an influential factor on the expression levels of SP1 in stroke samples (p-value = 0.037). CONCLUSION Our results suggested that DVT inhibitor SP1 could be a novel therapeutic target gene for post-stroke treatment. Further study of the potential relations between SP1 and stroke was guaranteed.
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Affiliation(s)
- Xixi Xiang
- State Key Laboratory of Trauma, Burns and Combined Injury; Medical Center of Hematology, The Second Affiliated Hospital of Army Medical University, Key Subject of Chongqing, No. 83 Xinqiao Street, Shapingba District, Chongqing, 400037, PR China
| | - Di Yuan
- Department of Educational Technology, College of Basic Medical Sciences, Army Medical University, Chongqing, 400038, China
| | - Peiyan Kong
- State Key Laboratory of Trauma, Burns and Combined Injury; Medical Center of Hematology, The Second Affiliated Hospital of Army Medical University, Key Subject of Chongqing, No. 83 Xinqiao Street, Shapingba District, Chongqing, 400037, PR China
| | - Ting Chen
- State Key Laboratory of Trauma, Burns and Combined Injury; Medical Center of Hematology, The Second Affiliated Hospital of Army Medical University, Key Subject of Chongqing, No. 83 Xinqiao Street, Shapingba District, Chongqing, 400037, PR China
| | - Han Yao
- State Key Laboratory of Trauma, Burns and Combined Injury; Medical Center of Hematology, The Second Affiliated Hospital of Army Medical University, Key Subject of Chongqing, No. 83 Xinqiao Street, Shapingba District, Chongqing, 400037, PR China
| | - Shijia Lin
- State Key Laboratory of Trauma, Burns and Combined Injury; Medical Center of Hematology, The Second Affiliated Hospital of Army Medical University, Key Subject of Chongqing, No. 83 Xinqiao Street, Shapingba District, Chongqing, 400037, PR China
| | - Xi Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury; Medical Center of Hematology, The Second Affiliated Hospital of Army Medical University, Key Subject of Chongqing, No. 83 Xinqiao Street, Shapingba District, Chongqing, 400037, PR China.
| | - Hongbao Cao
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, 030001, Shanxi Province, China.
- School of Systems Biology, George Mason University, Fairfax, Virginia, 22030, USA.
- Department of Genomics Research, RD Solutions, Elsevier Inc., Rockville, MD, 20852, USA.
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4
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Liang F, Chao M, Li JB, Ye XM. Characteristics and risk factors of deep vein thrombosis in hemiplegic, healthy and bilateral limbs of hemiplegic patients: a 10-year retrospective study. J Thromb Thrombolysis 2020; 51:798-804. [PMID: 32852670 DOI: 10.1007/s11239-020-02254-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Abstract
Deep vein thrombosis (DVT) in hemiplegic patients mainly affects hemiplegic limbs, DVT can also occur only in healthy limbs, and some hemiplegic patients have DVT in both limbs. Characteristics and risk factors of DVT in hemiplegic, healthy, and bilateral limbs are unknown. To describe the proportion, risk factors, extent, and timing of DVT in hemiplegic, healthy and bilateral limbs. A 10-year retrospective review of consecutive patients was performed. DVT affected hemiplegic limbs in 34 (62%), healthy limbs in 11 (20%), and was bilateral in 10 (18%). DVT was more likely to develop in healthy limbs of hemiplegic patients without surgery (odds ratio (OR) 0.022; 95% confidence interval (CI) 0.001-0.922), and without diabetes (OR 0.023, 95% CI 0.001-0.853). Among the veins at the level of which DVT occurred, intermuscular veins represented 20 (45%) in hemiplegic, 5 (37%) in healthy, and 6 (74%) in bilateral limbs. The median time that DVT occurred after hemiplegia onset was 18 days (interquartile range [IQR] 9-79) in hemiplegic, 17 days (IQR 10-56) in healthy, and 21 days (IQR 8-27) in bilateral limbs. Early and effective prevention of DVT after surgery and optimal management of diabetes may reduce the risk of DVT in bilateral limbs. It's important to prevent proximal extension of calf vein DVT. DVT prophylaxis should be started early and continued for at least 3 weeks after hemiplegia onset.
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Affiliation(s)
- Feng Liang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No.158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China
| | - Min Chao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jue-Bao Li
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No.158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China
| | - Xiang-Ming Ye
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, No.158, Shangtang Road, Xiacheng District, Hangzhou, 310014, Zhejiang, China.
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5
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Kim WJ, Bae S, Kang CJ, Kim DY. Clinical Factors Associated with Deep Vein Thrombosis in Rehabilitation Patients Suspected of Thromboembolism after Cerebral Infarction. BRAIN & NEUROREHABILITATION 2019; 13:e7. [PMID: 36744188 PMCID: PMC9879456 DOI: 10.12786/bn.2020.13.e7] [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] [Received: 10/10/2019] [Revised: 10/25/2019] [Accepted: 10/27/2019] [Indexed: 11/08/2022] Open
Abstract
The aim of this study is to investigate the association between characteristics of cerebral infarction lesion (vascular territory, etiology, and size), functional status and the occurrence of thromboembolism in patients suspected of having thromboembolism in a rehabilitation setting after cerebral infarction. Cerebral infarction patients who were suspected of having thromboembolism and who had undergone deep vein thrombosis (DVT) evaluation were included in analyses. Of the total 916 cerebral infarction patients, 65 patients were suspected of having DVT; 27 patients belonged to the DVT group and 38 patients belonged to the non-DVT group. The DVT (+) group was more likely to have a higher ratio of female, previous DVT history, middle cerebral artery (MCA) infarction, large arterial disease, modified Rankin Scale (mRS) score 5, abnormal speech and higher D-dimer. In multivariate logistic regression analysis, female sex, MCA infarction and mRS score 5 were significantly associated with the occurrence of thromboembolism in patients suspected of having thromboembolism. In contrast, other functional status, cerebral infarction etiology (Trial of ORG 10172 in Acute Stroke Treatment [TOAST] classification), and infarct volume were not associated with the occurrence of thromboembolism. In this study, female gender, MCA infarction, and mRS score 5 could be potential risk factors for thromboembolism in rehabilitation patients after cerebral infarction.
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Affiliation(s)
- Won Jun Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suhwan Bae
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheon Ji Kang
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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6
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Ianosi B, Gaasch M, Rass V, Huber L, Hackl W, Kofler M, Schiefecker AJ, Addis A, Beer R, Rhomberg P, Pfausler B, Thomé C, Ammenwerth E, Helbok R. Early thrombosis prophylaxis with enoxaparin is not associated with hematoma expansion in patients with spontaneous intracerebral hemorrhage. Eur J Neurol 2018; 26:333-341. [DOI: 10.1111/ene.13830] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- B. Ianosi
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - M. Gaasch
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - V. Rass
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - L. Huber
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
| | - W. Hackl
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
| | - M. Kofler
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - A. J. Schiefecker
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - A. Addis
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
- Department of Clinical and Experimental Medicine; University of Sassari; Sassari Italy
| | - R. Beer
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - P. Rhomberg
- Department of Neuroradiology; Medical University of Innsbruck; Innsbruck
| | - B. Pfausler
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - C. Thomé
- Department of Neurosurgery; Medical University of Innsbruck; Innsbruck Austria
| | - E. Ammenwerth
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
| | - R. Helbok
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
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7
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Kim H, Lee K, Choi HA, Samuel S, Park JH, Jo KW. Elevated Blood Urea Nitrogen/Creatinine Ratio Is Associated with Venous Thromboembolism in Patients with Acute Ischemic Stroke. J Korean Neurosurg Soc 2017; 60:620-626. [PMID: 29142620 PMCID: PMC5678066 DOI: 10.3340/jkns.2016.1010.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 01/25/2017] [Accepted: 03/14/2017] [Indexed: 11/27/2022] Open
Abstract
Objective Although venous thromboembolism (VTE) is frequently related to dehydration, the impact of dehydration on VTE in acute ischemic stroke (AIS) is not clear. This study investigated whether dehydration, as measured by blood urea nitrogen (BUN)/creatinine (Cr) ratio, influences the occurrence of VTE in patients with AIS. Methods This is a retrospective study of patients with AIS between January 2012 and December 2013. Patients with newly diagnosed AIS who experienced prolonged hospitalization for at least 4 weeks were included in this study. Results Of 182 patients included in this study, 17 (9.3%) suffered VTE during the follow-up period; in two cases, VTE was accompanied by deep vein thrombosis and pulmonary embolism. Patients with VTE were more frequently female and had higher National Institutes of Health Stroke Scale (NIHSS) score, more lower limb weakness, and elevated blood urea nitrogen BUN/Cr ratio on admission. In a multivariate analysis, BUN/Cr ratio >15 (odds ratio [OR] 8.75) and severe lower limb weakness (OR 4.38) were independent risk factors for VTE. Conclusion Dehydration on admission in cases of AIS might be a significant independent risk factor for VTE.
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Affiliation(s)
- Hoon Kim
- Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Kiwon Lee
- Department of Neurosurgery and Neurology, The University of Texas Medical School, Houston, TX, USA
| | - Huimahn A Choi
- Department of Neurosurgery and Neurology, The University of Texas Medical School, Houston, TX, USA
| | - Sophie Samuel
- Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, TX, USA
| | - Jung Hyn Park
- Department of Neurosurgery, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea
| | - Kwang Wook Jo
- Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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Balogun IO, Roberts LN, Patel R, Pathansali R, Kalra L, Arya R. Clinical and laboratory predictors of deep vein thrombosis after acute stroke. Thromb Res 2016; 142:33-9. [DOI: 10.1016/j.thromres.2016.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/10/2016] [Accepted: 04/01/2016] [Indexed: 10/22/2022]
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9
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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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Abstract
Stroke and especially its complications are a leading cause of death. Despite reduced morbidity in some developed countries, mortality in stroke patients is still high worldwide. In the past decades, treatment of acute stroke has focused on early intervention, such as revascularization and cerebral edema prevention. However, long-term clinical observations indicate that poststroke pneumonia, cardiovascular complications, and vascular embolism are the major reasons for the increased death rate after stroke. Few evidence-based data are available currently to guide the management of these complications. Thus, systematic studies of these adverse events are essential and urgent to improve survival after stroke.
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Bottinor W, Turlington J, Raza S, Roberts CS, Malhotra R, Jovin IS, Abbate A. Life-saving systemic thrombolysis in a patient with massive pulmonary embolism and a recent hemorrhagic cerebrovascular accident. Tex Heart Inst J 2014; 41:174-6. [PMID: 24808778 DOI: 10.14503/thij-12-3010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Massive pulmonary embolism is associated with mortality rates exceeding 50%. Current practice guidelines include the immediate administration of thrombolytic therapy in the absence of contraindications. However, thrombolysis for pulmonary embolism is said to be absolutely contraindicated in the presence of recent hemorrhagic stroke and other conditions. The current contraindications to thrombolytic therapy have been extrapolated from data on acute coronary syndrome and are not specific for venous thromboembolic disease. Some investigators have proposed that the current contraindications be viewed as relative, rather than absolute, in cases of high-risk pulmonary embolism. We present the case of a 60-year-old woman in whom massive pulmonary embolism led to cardiac arrest with pulseless electrical activity. Eight weeks earlier, she had sustained a hemorrhagic cerebrovascular accident-a classic absolute contraindication to thrombolytic therapy. Despite this practice guideline, we administered tissue plasminogen activator systemically in order to save the patient's life. This therapy did not evoke intracranial bleeding, and the patient was eventually discharged from the hospital. Until guidelines specific to venous thromboembolic disease are developed, we think that the current contraindications to thrombolysis should be considered on an individual basis in patients who are at high risk of death from massive pulmonary embolism.
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Affiliation(s)
- Wendy Bottinor
- Department of Internal Medicine (Drs. Bottinor and Turlington) and Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine (Dr. Malhotra), Virginia Commonwealth University Health System; Pauley Heart Center Division of Cardiology (Drs. Abbate, Jovin, and Raza, and Ms Roberts); Richmond, Virginia 23298; and Division of Cardiology (Dr. Jovin), Hunter Holmes McGuire VA Medical Center, Richmond, Virginia 23249
| | - Jeremy Turlington
- Department of Internal Medicine (Drs. Bottinor and Turlington) and Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine (Dr. Malhotra), Virginia Commonwealth University Health System; Pauley Heart Center Division of Cardiology (Drs. Abbate, Jovin, and Raza, and Ms Roberts); Richmond, Virginia 23298; and Division of Cardiology (Dr. Jovin), Hunter Holmes McGuire VA Medical Center, Richmond, Virginia 23249
| | - Syed Raza
- Department of Internal Medicine (Drs. Bottinor and Turlington) and Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine (Dr. Malhotra), Virginia Commonwealth University Health System; Pauley Heart Center Division of Cardiology (Drs. Abbate, Jovin, and Raza, and Ms Roberts); Richmond, Virginia 23298; and Division of Cardiology (Dr. Jovin), Hunter Holmes McGuire VA Medical Center, Richmond, Virginia 23249
| | - Charlotte S Roberts
- Department of Internal Medicine (Drs. Bottinor and Turlington) and Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine (Dr. Malhotra), Virginia Commonwealth University Health System; Pauley Heart Center Division of Cardiology (Drs. Abbate, Jovin, and Raza, and Ms Roberts); Richmond, Virginia 23298; and Division of Cardiology (Dr. Jovin), Hunter Holmes McGuire VA Medical Center, Richmond, Virginia 23249
| | - Rajiv Malhotra
- Department of Internal Medicine (Drs. Bottinor and Turlington) and Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine (Dr. Malhotra), Virginia Commonwealth University Health System; Pauley Heart Center Division of Cardiology (Drs. Abbate, Jovin, and Raza, and Ms Roberts); Richmond, Virginia 23298; and Division of Cardiology (Dr. Jovin), Hunter Holmes McGuire VA Medical Center, Richmond, Virginia 23249
| | - Ion S Jovin
- Department of Internal Medicine (Drs. Bottinor and Turlington) and Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine (Dr. Malhotra), Virginia Commonwealth University Health System; Pauley Heart Center Division of Cardiology (Drs. Abbate, Jovin, and Raza, and Ms Roberts); Richmond, Virginia 23298; and Division of Cardiology (Dr. Jovin), Hunter Holmes McGuire VA Medical Center, Richmond, Virginia 23249
| | - Antonio Abbate
- Department of Internal Medicine (Drs. Bottinor and Turlington) and Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine (Dr. Malhotra), Virginia Commonwealth University Health System; Pauley Heart Center Division of Cardiology (Drs. Abbate, Jovin, and Raza, and Ms Roberts); Richmond, Virginia 23298; and Division of Cardiology (Dr. Jovin), Hunter Holmes McGuire VA Medical Center, Richmond, Virginia 23249
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12
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Qin J, Xu Z, Shi D, Chen D, Dai J, Teng H, Jiang Q. Deep Vein Thrombosis After Total Hip Arthroplasty and Total Knee Arthroplasty in Patients With Previous Ischemic Stroke. INT J LOW EXTR WOUND 2013; 12:316-9. [PMID: 24043672 DOI: 10.1177/1534734613493291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study evaluated the prevalence and therapy of deep vein thrombosis (DVT) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in 57 patients with previous ischemic stroke. Postoperative anticoagulants were used for DVT prophylaxis, and batroxobin and prolonged anticoagulants were used for thrombolysis in DVT subjects. The incidence of DVT after THA and TKA in patients with previous ischemic stroke was 16.2% and 20%, respectively. No bleeding complications were observed and no new ischemic stroke occurred during the following 3 months. The prevalence DVT after THA and TKA in patients with previous ischemic stroke was not specific, and the treatment of DVT with batroxobin and anticoagulants was effective and safe.
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Affiliation(s)
- Jizheng Qin
- Drum Tower Hospital Affiliated to Medical School of Nanjing University, Jiangsu, People’s Republic of China
- Nanjing University, Jiangsu, People’s Republic of China
| | - Zhihong Xu
- Drum Tower Hospital Affiliated to Medical School of Nanjing University, Jiangsu, People’s Republic of China
- Nanjing University, Jiangsu, People’s Republic of China
| | - Dongquan Shi
- Drum Tower Hospital Affiliated to Medical School of Nanjing University, Jiangsu, People’s Republic of China
- Nanjing University, Jiangsu, People’s Republic of China
| | - Dongyang Chen
- Drum Tower Hospital Affiliated to Medical School of Nanjing University, Jiangsu, People’s Republic of China
- Nanjing University, Jiangsu, People’s Republic of China
| | - Jin Dai
- Drum Tower Hospital Affiliated to Medical School of Nanjing University, Jiangsu, People’s Republic of China
- Nanjing University, Jiangsu, People’s Republic of China
| | - Huajian Teng
- Nanjing University, Jiangsu, People’s Republic of China
| | - Qing Jiang
- Drum Tower Hospital Affiliated to Medical School of Nanjing University, Jiangsu, People’s Republic of China
- Nanjing University, Jiangsu, People’s Republic of China
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13
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Abstract
BACKGROUND Rebleeding is an important cause of death and disability in patients with aneurysmal subarachnoid haemorrhage (SAH). In order to prevent rebleeding, the preferred strategy is aneurysm ablation (removal) as early as possible. However, in clinical practice some patients are not suitable for surgical treatment, or prefer conservative treatments. In some countries, therefore, total bedrest for four to six weeks has been considered one of the basic interventions to avoid rebleeding. However, the influence of bedrest on outcome in patients with SAH is not well known. OBJECTIVES To establish whether early mobilisation (less than four weeks after symptom onset) compared with delayed mobilisation (defined as patients staying in bed for at least four weeks after symptom onset) in patients with aneurysmal subarachnoid haemorrhage (SAH), who have not had or could not have any surgical treatment for the aneurysm, will increase the proportion of deaths from rebleeding. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6), the Chinese Stroke Trials Register (May 2012), MEDLINE (1950 to June 2012), EMBASE (1980 to June 2012), Web of Science Conference Proceedings (1990 to May 2012), CINAHL (1982 to June 2012), AMED (1985 to June 2012), PEDro (May 2012), REHABDATA (May 2012) and CIRRIE Database of International Rehabilitation Research (May 2012). In addition, we searched five Chinese databases, ongoing trials registers and relevant reference lists. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs) comparing early mobilisation (within four weeks after symptom onset) with delayed mobilisation (after four weeks). DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion and exclusion. We resolved disagreements by discussion. MAIN RESULTS In the absence of any suitable RCTs addressing this topic, we were unable to perform a meta-analysis. Data from recent observational studies suggested the period of greatest risk for rebleeding occurs more frequently in the early period, especially within 24 hours of the initial SAH. The impact of bedrest on aneurysm care should be clarified. AUTHORS' CONCLUSIONS There are no RCTs or controlled trials that provide evidence for, or against, staying in bed for at least four weeks after symptom onset in patients with aneurysmal SAH, who have not had, or could not have, surgical treatment for the aneurysm. Treatment strategies to reduce the risk of rebleeding in SAH patients before aneurysm ablation, or in those not suitable for surgical treatment, or who prefer conservative treatments, deserve attention.
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Affiliation(s)
- Zhenxing Ma
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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14
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Chen CC, Lee TH, Chung CY, Chang WH, Hong JP, Huang LT, Tang SFT, Chen CK. Symptomatic pulmonary embolism among stroke patients in Taiwan: a retrospective cohort study. Top Stroke Rehabil 2012; 19:361-8. [PMID: 22982822 DOI: 10.1310/tsr1905-361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stroke patients are at particular risk for developing pulmonary embolism (PE), which is a cardiovascular emergency associated with a high mortality rate. Little information is available on symptomatic PE in Asian stroke patients. OBJECTIVE To determine the frequency of symptomatic PE in ischemic and hemorrhagic stroke patients; to identify common characteristics and risk factors of symptomatic PE in Taiwanese stroke patients; and to compare the difference between fatal PE and nonfatal PE among these stroke patients. METHODS This is a retrospective cohort study of stroke patients admitted between January 2002 and December 2009 to a tertiary referral center in Northern Taiwan. We used the International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify eligible patients. We determined annual frequency and risk factors of symptomatic PE. We also compared the difference between ischemic stroke patients with fatal and nonfatal PE. RESULTS Among the admitted stroke patients, 21,129 (78.87%) had ischemic strokes and 5,662 (21.13 %) had hemorrhagic strokes. There were 14 (0.066%) ischemic and 1 hemorrhagic stroke (0.018%) patients included in this study. Of the recruited stroke patients, 64.29% had past heart disease history, especially atrial fibrillation (42.86%). Patients with fatal PE showed a significantly lower poststroke Glasgow Coma Scale (GCS) motor component than patients with nonfatal PE. CONCLUSIONS Symptomatic PE is not common in stroke patients in Taiwan. Clinicians need to keep this fatal disease in mind, especially for persons with heart disease like atrial fibrillation. Stroke patients with impaired poststroke GCS motor components seemed to have a greater mortality risk if they have symptomatic PE.
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Affiliation(s)
- Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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15
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Bembenek JP, Karlinski M, Kobayashi A, Czlonkowska A. Deep venous thrombosis in acute stroke patients. Clin Appl Thromb Hemost 2011; 18:258-64. [PMID: 22067545 DOI: 10.1177/1076029611424575] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Deep venous thrombosis (DVT) is a complication of stroke. Our aim was to determine the frequency of DVT in patients with acute stroke, risk factors for its development, and its influence on the 3-month outcome. A total of 323 consecutive patients with acute stroke were enrolled. We performed ultrasound imaging within 7 days after stroke. Deep venous thrombosis was found in 8.7% of patients, only in those with ischemic stroke. Patients with DVT were more frequently female (71.4% vs 49.5%), had prestroke Modified Rankin scale (mRS) 3 to 5 (42.9% vs 15.3%), elevated C-reactive protein (CRP) serum level (65.4% vs 32.5%), and a trend toward elevated serum fibrinogen level (85.7% vs 70.1%; P = .08). In a multivariate analysis, elevated CRP (odds ratio [OR] 3.15) and prestroke disability (OR 2.89) were independent risk factors for DVT. Deep venous thrombosis occurs in <10% of patients with acute stroke and does not significantly affect the 3-month outcome. Prestroke dependency and elevated CRP level at baseline are independent risk factors for DVT.
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Affiliation(s)
- Jan P Bembenek
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
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16
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Stein PD, Matta F. Epidemiology and Incidence: The Scope of the Problem and Risk Factors for Development of Venous Thromboembolism. Crit Care Clin 2011; 27:907-32, vii. [DOI: 10.1016/j.ccc.2011.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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17
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Bembenek JP, Czlonkowska A, Karlinski M, Kobayashi A. Early stroke-related DVT is more than just DVT diagnosed early after stroke onset. Thromb Res 2011; 128:587-9. [PMID: 21872300 DOI: 10.1016/j.thromres.2011.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/23/2011] [Accepted: 07/18/2011] [Indexed: 11/29/2022]
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18
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Field TS, Hill MD. Prevention of Deep Vein Thrombosis and Pulmonary Embolism in Patients With Stroke. Clin Appl Thromb Hemost 2011; 18:5-19. [DOI: 10.1177/1076029611412362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Venous thromboembolism (VTE), encompassing deep venous thrombosis and pulmonary embolism, is a potentially fatal but preventable complication of stroke. Reported rates of VTE after stroke have decreased over the last four decades, possibly due to the implementation of stroke units, early mobilization and hydration, and increased early use of antiplatelets. Additional means of thromboprophylaxis in stroke include mechanical methods (ie, compression stockings) to prevent venous stasis and medical therapy including antiplatelets, heparins, and heparinoids. Risk of VTE must be balanced by potential risk of hemorrhagic complications from pharmacotherapy. Unfractionated heparin, low-molecular-weight heparin (LMWH), and danaparoid are acceptable options for chemoprophylaxis though none have shown superior efficacy for VTE prevention without an associated increase in major hemorrhage. The efficacy and timing of pharmacological thromboprophylaxis in hemorrhagic stroke are not well defined. Graduated compression stockings are associated with an increased rate of adverse events and are not recommended and intermittent pneumatic compression stockings require further investigation.
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Affiliation(s)
- Thalia S. Field
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Michael D. Hill
- Departments of Clinical Neurosciences, Medicine, Rardiology and Community Health Sciences, Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, AB Canada
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Bembenek J, Karlinski M, Kobayashi A, Czlonkowska A. Early stroke-related deep venous thrombosis: risk factors and influence on outcome. J Thromb Thrombolysis 2011; 32:96-102. [PMID: 21359647 PMCID: PMC3111553 DOI: 10.1007/s11239-010-0548-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Deep venous thrombosis (DVT) is a serious complication of various medical conditions including acute stroke. Our aim was to identify the occurrence of early stroke-related DVT, risk factors for its development and the influence on outcome. The study involved consecutive patients admitted to our center due to acute ischaemic (n = 278) or haemorrhagic (n = 12) stroke during a 16-month period. We collected data on their pre-stroke health status, neurological deficit on admission and baseline serum CRP and fibrinogen level. Ultrasonographic imaging was performed at the 3rd (IQR: 2-4) and 9th (IQR: 8-9) day after stroke. Patients thrombosis occurring between the first and second examination comprised the newly developed early stroke-related DVT group. We found DVT in 8.0% (24/299) of patients at initial evaluation. Newly developed DVT was present in 3.0% (9/299) of patients, and was predominantly distal (7 of 9 cases). It was associated with elevated serum CRP level (OR 8.75; 95%CI: 1.61-47.6), which was verified in a model adjusted for stroke severity and pre-stroke dependency (3-5 pts. in mRS). In a multivariate model, newly developed DVT significantly increased the risk of 3-month mortality (OR 12.4; 95%CI: 1.72-89.4), without affecting the combined risk of dependency and death (OR 2.57; 95%CI: 0.39-17.0). Early stroke-related DVT is an infrequent complication. However, it may be an independent risk factor for 3-month mortality. Increased serum CRP level combined with normal fibrinogen level seems predictive for development of DVT. It may be reasonable to provide those patients with additional DVT prophylaxis.
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Affiliation(s)
- Jan Bembenek
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
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20
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Epidemiology and Incidence: The Scope of the Problem and Risk Factors for Development of Venous Thromboembolism. Clin Chest Med 2010; 31:611-28. [DOI: 10.1016/j.ccm.2010.07.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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21
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Deep venous thrombosis after acute intracerebral hemorrhage. J Neurol Sci 2008; 272:83-6. [PMID: 18555486 DOI: 10.1016/j.jns.2008.04.032] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 04/28/2008] [Accepted: 04/29/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND We evaluated the incidence of deep venous thrombosis (DVT) and the characteristics of patients with acute ICH who developed DVT. METHODS We enrolled 52 patients with acute ICH between June 2005 and September 2006. We recorded their stroke risk factors, neurological deficit, hemorrhage size and laboratory data, and performed ultrasonography to detect DVT within 72 h of onset of ICH and after two weeks. RESULTS DVT was detected a total of 21 patients (40.4%) after two weeks. Patients with DVT tended to be older, and had significantly more severe disturbance of consciousness (p=0.020) and paralysis (p=0.035) on admission than those without DVT. The National Institutes of Health Stroke Scale (NIHSS) score was significantly higher in patients with DVT than those without (p=0.002). Patients with a larger diameter of ICH were more likely to develop DVT (p=0.021). D-dimer value on admission was significantly higher in patients with DVT than those without (p=0.002). Logistic regression analysis indicated that both NIHSS score and D-dimer value were independent risk factors for the occurrence of DVT. CONCLUSIONS We need be aware that acute ICH patients with severe neurological deficit and high D-dimer value are at increased risk of developing DVT.
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Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EFM. Guidelines for the Early Management of Adults With Ischemic Stroke. Circulation 2007; 115:e478-534. [PMID: 17515473 DOI: 10.1161/circulationaha.107.181486] [Citation(s) in RCA: 657] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose—
Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included.
Methods—
Members of the panel were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee and represented different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council’s Levels of Evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years.
Results—
Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials. This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital. Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke. Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed.
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23
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Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EFM. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007; 38:1655-711. [PMID: 17431204 DOI: 10.1161/strokeaha.107.181486] [Citation(s) in RCA: 1511] [Impact Index Per Article: 88.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. METHODS Members of the panel were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and represented different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council's Levels of Evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years. RESULTS Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials. This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital. Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke. Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed.
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Poststroke Complications and Risk Factors: Implications for Primary Care Nurse Practitioners. J Nurse Pract 2006. [DOI: 10.1016/j.nurpra.2006.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Skaf E, Stein PD, Beemath A, Sanchez J, Bustamante MA, Olson RE. Venous thromboembolism in patients with ischemic and hemorrhagic stroke. Am J Cardiol 2005; 96:1731-3. [PMID: 16360366 DOI: 10.1016/j.amjcard.2005.07.097] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Revised: 07/15/2005] [Accepted: 07/15/2005] [Indexed: 11/15/2022]
Abstract
The rates of pulmonary embolism (PE), deep venous thrombosis (DVT), and their combination, venous thromboembolism (VTE), in hospitalized patients with stroke from 1979 to 2003 were determined from the National Hospital Discharge Survey. Of 14,109,000 patients hospitalized with ischemic stroke, PE occurred in 72,000 (0.51%), DVT in 104,000 (0.74%), and VTE in 165,000 (1.17%). Of 1,606,000 patients hospitalized with hemorrhagic stroke, rates were higher: PE occurred in 11,000 (0.68%), DVT in 22,000 (1.37%), and VTE in 31,000 (1.93%). The rates of VTE with ischemic stroke and with hemorrhagic stroke did not change over the 25-year period of observation.
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Affiliation(s)
- Elias Skaf
- St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA
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