Abstract
Chua K, Kong KH, Chan SP. Prevalence and risk factors of asymptomatic lower extremity
deep venous thrombosis in Asian neurorehabilitation admissions in Singapore.
Objective
To determine the local prevalence and risk factors of asymptomatic lower limb deep
venous thrombosis (DVT) among neurorehabilitation admissions.
Design
A prospective observational single-center study.
Setting
Tertiary rehabilitation center affiliated to a public hospital.
Participants
A total of 419 Asian neurorehabilitation admissions with a mean of 26 days to rehabilitation.
Intervention
Admission screening protocol included quantitative D-dimer assay within 24 to 48 hours
of rehabilitation admission and targeted hemiplegic/weaker lower-extremity venous
duplex ultrasonography was performed if D-dimer assay level was elevated at 0.34 μg/mL
or higher.
Main Outcome Measures
There were 251 (59.9%) men, and the subjects were predominantly Chinese (76.6%). Subjects
had a mean age of 59±15 years. Admitting diagnoses included ischemic stroke (212),
hemorrhagic stroke and subarachnoid hemorrhage (129), traumatic brain injury (59),
and nontraumatic brain injury (19). The screening protocol included a quantitative
D-dimer assay within 24 to 48 hours of rehabilitation admission, and hemiplegic/weaker
lower-extremity venous duplex ultrasonography was performed if D-dimer assay level
was elevated at 0.34 μg/mL or higher.
Results
Altogether, 247 (58.9%) patients had an elevated D-dimer assay, and all underwent
venous duplex ultrasonography. The incidence of lower-limb DVT was 5.01% (21), including
11 proximal and 10 distal DVT. No patients had clinical pulmonary embolism. Using
247 venous duplex ultrasonography results for analyses of correlates with logistic
regression analyses, no significant demographic or clinical predictive factors for
DVT were found.
Conclusions
This study confirms that asymptomatic lower limb DVT is indeed uncommon in Asian neurorehabilitation
admissions. Possible reasons include genetic or ethnic protective factors, early walking
initiated at rehabilitation, and timing of the admission protocol (median of 14 days
postevent) when the maximal thrombotic risk was on the decline.
Key Words
List of Abbreviations:
BI (brain injury), CI (confidence interval), DVT (deep venous thrombosis), GCS (Glasgow Coma Scale), LOS (length of stay), OR (odds ratio), PE (pulmonary embolism), PTA (posttraumatic amnesia), SAH (subarachnoid hemorrhage), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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References
- Venous thromboembolism after acute stroke.Stroke. 2001; 32: 262-267
- Incidence and distribution of lower extremity deep vein thrombosis in rehabilitation patients: implications for screening.Vasc Endovascular Surg. 2006; 40: 205-211
- Venous thrombosis following strokes.Lancet. 1972; 1: 1305-1306
- The long-term clinical course of acute deep venous thrombosis.Ann Intern Med. 1996; 125: 1-7
- Diagnoses of lower limb deep venous thrombosis (DVT): prospective blinded analysis of magnetic resonance direct thrombus imaging.Vessel WMI Mechanics and Morphology; Society of Magnetic Resonance in Medicine. 2000 (April 2-7; Denver, CO. Abstract 364)
- Venous thromboembolism after acute ischaemic stroke: a prospective study using magnetic resonance direct thrombus imaging.Stroke. 2004; 35: 2320-2326
- Screening for proximal deep vein thrombosis after acute ischaemic stroke: a prospective study using clinical factors and plasmas D-dimers.J Thromb Haemost. 2004; 1: 1321-1326
- Deep venous thrombosis after stroke.Stroke. 2006; 27: 1516-1520
- Value of the D-dimer test in diagnosing deep vein thrombosis in rehabilitation inpatients.Arch Phys Med Rehabil. 2004; 85: 1091-1094
- Venous thromboembolism in patients undergoing rehabilitation for stroke.Arch Phys Med Rehabil. 1992; 73: 712-716
- Occult proximal deep venous thrombosis: its prevalence among patients admitted to a rehabilitation hospital.Arch Phys Med Rehabil. 1988; 69: 183-185
- Prevalence and risk factors in rehabilitation admissions with brain injury.Neurology. 2004; 63: 485-491
- Deep venous thrombosis: incidence on admission to a brain injury rehabilitation program.Arch Phys Med Rehabil. 1996; 77: 1182-1185
- Cost-effectiveness of routine screening for proximal deep venous thrombosis in acquired brain injury patients admitted to rehabilitation.Arch Phys Med Rehabil. 1996; 77: 1-5
- New aspects of the blood coagulation cascade, anticoagulants and vein thrombosis in Asia.Ann Acad Med Singapore. 2002; 31: 685-696
- Study on the risk factors of deep venous thrombosis in acute hospitalised stroke patients.Zhonghua Liu Xing Bing Xue Za Zhi. 2004; 25: 1010-1023
- Deep vein thrombosis is not rare in Asia: the Singapore General Hospital experience.Ann Acad Med Singapore. 2002; 31: 761-764
- Is post-operative deep vein thrombosis a problem in neurosurgical patients with brain tumours in Singapore?.Singapore Med J. 2002; 43: 345-349
- Deep vein thrombosis following ischaemic stroke among Asians.Cerebrovasc Dis. 2006; 22: 245-250
- Assessing motor impairment after stroke: a pilot reliability study.J Neurol Neurosurg Psychiatry. 1990; 53: 576-579
- The FIM (TM).(The Center for Outcome Measurement in Brain Injury)2000 (Accessed September 17, 2008)
- Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome.J Trauma. 2002; 52: 907-911
- Long term outcomes after severe head injury.BMJ. 1979; 2: 1533-1538
- Population and health facts, Singapore 2007.(Accessed September 17, 2008)
- Incidence of idiopathic deep vein thrombosis and secondary thromboembolism among ethnic groups in California.Ann Intern Med. 1998; 128: 737-740
- Deep venous thrombosis after strokes in Chinese.Aust N Z J Med. 1980; 10: 513-514
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Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Reprints are not available from the author.
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Copyright
© 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
