Clinical Risk Factors of Asymptomatic Deep Venous Thrombosis in Patients With Acute Stroke
Clinical Risk Factors of Asymptomatic Deep Venous Thrombosis in Patients With Acute Stroke
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急性脑卒中患者无症状深静脉血栓形成的临床危险因素
DOI：
10.1177/1076029619868534
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发表时间：
2019-08-19
影响因子：
2.9
通讯作者：
Fang, Kun
中科院分区：
文献类型：
--
作者：
Wang, Yi;Shi, Yu;Fang, Kun
背景：深静脉血栓形成（DVT）是脑卒中后常见的并发症。有症状的DVT患者易于识别;但无症状高危人群的工具需要进一步探索。本研究旨在探讨急性脑卒中患者并发无症状DVT的危险因素。方法：我们对452例14天内发生中风的急性中风患者进行了前瞻性观察研究。每例DVT患者入院后每7天重复进行深静脉超声检查。分析急性脑卒中患者DVT的动态发生率。比较DVT患者与非DVT患者的危险因素。以考克斯比例模型为基础，探索了预测模型。结果：52例（11.5%）脑卒中患者出现无症状DVT，85.9%血栓位于远端静脉。在调整年龄和性别后，住院时间较长（P = 0.004）、卒中较严重（P = 0.001）、D-二聚体水平较高（P = 0.003）和血糖水平较高的患者发生DVT的风险较高，而甘油三酯水平较高（P = 0.003）的患者发生DVT的可能性较小。以D-二聚体中位数（0.38 FEU mg/L）为界值。D-二聚体水平越高，患者发生DVT的危险性越高，差异有统计学意义。在Kaplan-Meier模型中，卒中严重程度与DVT风险不同。用Cox比例风险回归模型可以预测无症状DVT（曲线下面积0.852）。结论：急性脑卒中患者多为无症状性DVT，血栓多发生在远端静脉。结合临床表现和实验室检查结果有助于预测DVT。DVT预防应考虑高危人群。
Background: Deep venous thrombosis (DVT) is a common complication after stroke. It is easy to identify the patients with symptomatic DVT; however, the tool for asymptomatic high-risk population needs to be further explored. Our aim was to explore the risk factors of acute stroke patients with asymptomatic DVT. Methods: We performed a prospective observation study among 452 patients with acute stroke who had a stroke within 14 days. Ultrasound examination of deep veins was repeatedly performed in each patient for DVT every 7 days during his admission. The dynamic rate of DVT in acute stroke was analyzed. Then risk factors were compared between DVT patients and non-DVT patients. The predictive model was explored based on thr cox proportion model. Results: Asymptomatic DVT was detected in 52 (11.5%) patients with stroke and 85.9% of thrombi were identified in their distal veins. Patients with longer length of stay (P = .004), more severe stroke (P = 0.001), higher level of D-dimer (P = .003), and higher blood glucose level were associated with higher risk of DVT, while patients with higher triglyceride level (P = .003) were less likely to have DVT, after adjusting age and sex. With the median of D-dimer (0.38 FEU mg/L) as cutoff value. Patients with higher level of D-dimer might have a higher risk of DVT with a significant statistical difference. Also, the severity of stroke differed DVT risk in Kaplan-Meier model. Using cox-proportion hazard regression model, asymptomatic DVT could be predicted (area under the curve 0.852). Conclusion: Our data showed that asymptomatic DVT was common in patients with acute stroke and most of thrombosis occurred in distal veins. Combination of clinical manifestation and laboratory results might be helpful predict DVT. DVT prophylaxis should be condisdered in high risk.