Predictors of venous thromboembolism in patients with ischemic stroke

Aim. To identify predictors of venous thromboembolism (VTE) in patients with ischemic stroke (IS). Material and methods. This single‑center prospective study had following inclusion criteria: 1) IS confirmed by neuroimaging, 2) length of hospital stay at the time of inclusion ≤72 h, 3) Rivermead Mobility Index (RMI) ≤3. A total of 126 patients were screened. The study involved 2 visits: on day 3±1 of hospitalization and day 10±1 of hospitalization. Patients without deep vein thrombosis (DVT) detected at the first visit, who did not have the second visit, were excluded from the study. The study group consisted of 94 patients. During the visits, lower limb vein and cardiac ultrasound and biomarker assessment were performed. If deep vein thrombosis was detected, CT pulmonary angiography was performed. Results. In total, 46 cases of DVT (49%) were detected in the studied group of patients with IS, including 26 "early" thromboses (DVT at visit 1) and 20 "late" thromboses (DVT diagnosed at visit 2). Predictors of "early" thromboses are white blood cell (WBC) count upon admission >10,6 (odds ratio (OR) 3,58, 95% confidence interval (CI): 1,12‑11,39, p=0,028) and Padua score >5 (OR 5,14, 95% CI: 1,62‑16,29, p=0,005). The following are proposed as predictors of "late" thrombosis: d‑dimer level on day 3 ≥3‑fold exceeding the upper reference limit (OR 26,6, 95% CI: 3,0232,9, p=0,004) and the ratio of anterior tibial vein (ATV) flow velocity on the affected side to the opposite one ≤0,90 (OR 4,1, 95% CI: 1,1‑15,4, p=0,039). Conclusion. In IS, there is a high rate of VTE (49%) among low‑mobility patients (RMI ≤3). Thrombosis can be divided into "early" (3±1 days) and "late" (10±1 days of hospitalization). Predictors of "early" thrombosis are Padua score >5 and WBC count on admission >10,6*109. Predictors of "late" thrombosis are 3‑fold increase in the d‑dimer upper reference level and the ratio of ATV flow velocity on the affected side to the opposite one ≤0,90 on day 3±1 of hospitalization.