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  • Title: Deep vein thrombosis based on D-dimer screening in ischaemic stroke patients undergoing rehabilitation.
    Author: Kong KH, Chua SG.
    Journal: Singapore Med J; 2009 Oct; 50(10):971-5. PubMed ID: 19907887.
    Abstract:
    INTRODUCTION: Although lower extremity deep vein thrombosis (DVT) is a common complication after an acute stroke, there is little local data documenting this condition in stroke patients undergoing rehabilitation. The purpose of this study was to determine the frequency and risk factors of DVT in ischaemic stroke patients admitted to a rehabilitation unit. METHODS: This was a prospective observational single-centre study of ischaemic stroke patients with lower limb paresis admitted to a rehabilitation centre. The screening protocol consisted of quantitative D-dimer assay (DDA) within 24-48 hours of rehabilitation admission followed by duplex Doppler ultrasonography (DUS) of the paretic lower extremity if the DDA level was elevated (equal or greater than 0.34 micro/ml). RESULTS: 212 patients (167 Chinese, 27 Malays, 17 Indians and one Eurasian) were screened at a mean of 23.2 days post-stroke. 121 (57.1 percent) patients had an elevated DDA, and all underwent ultrasonography. The incidence of lower limb DVT was 5.2 percent (11), consisting of four proximal and seven distal. DVT was significantly related to total anterior circulation infarct (odds ratio 3.69, 95 percent confidence interval 1.04-3.05, p-value is 0.043), but not to age, gender, race, severity of lower limb weakness, and ambulatory and functional status. No patients had clinical pulmonary embolism during rehabilitation. CONCLUSION: Locally, asymptomatic lower limb DVT based on a screening protocol of DDA and selective DUS, is uncommon in ischaemic stroke patients admitted to rehabilitation. Future research efforts could include a detailed evaluation of DDA's role as a screening tool for DVT in the stroke population, by comparing it to an established gold standard like venography.
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