Analysis of risk factors for asymptomatic deep venous thrombosis in patients with acute ischemic stroke

doi:10.3969/j.issn.1672-6731.2021.07.011

Abstract

Abstract:

Objective To explore the risk factors for asymptomatic deep venous thrombosis (DVT) in patients with acute ischemic stroke and determine the predictive value of risk indicators. Methods Two hundred thirty-nine acute ischemic stroke patients admitted to Beijing Shijitan Hospital, Capital Medical University from September 2018 to June 2019 met the inclusion criteria. According to the Doppler ultrasound results 7 d after admission, all eligible patients were screened for the presence of asymptomatic DVT. Univariate and multivariate Logistic regression analyses were used to identify risk factors for asymptomatic DVT. The value of risk factors for predicting asymptomatic DVT was analyzed by receiver operating characteristic curve (ROC) analysis. Results Thirty-seven (15.48%) patients with acute ischemic stroke had asymptomatic DVT. The multivariate forward Logistic regression analysis showed elevated D-dimer level on admission was the critical risk factor for asymptomatic DVT (OR=1.012, 95%CI:1.011-1.013; P=0.000). The cut-off value for plasma D-dimer in diagnosing asymptomatic DVT in the acute ischemic stroke patients was 343 ng/ml (sensitivity=0.784, specificity=0.901), and the area under the ROC curve was 0.89 ±0.03 (95%CI:0.846-0.929, P=0.000). Conclusions D-dimer is an essential marker of asymptomatic DVT in patients with acute ischemic stroke. Its elevated level is a potential risk factor for asymptomatic DVT.

Key words: Stroke, Brain ischemia, Venous thrombosis, Lower extremity, Risk factors, Logistic models

摘要：

目的探讨急性缺血性卒中患者无症状深静脉血栓形成危险因素并确定风险指标的预测界值。方法选择2018年9月至2019年6月经首都医科大学附属北京世纪坛医院确诊并符合纳入条件的239例急性缺血性卒中患者为观察对象，根据入院后7 d内多普勒超声结果筛查是否存在无症状深静脉血栓，通过单因素和多因素Logistic回归分析进行危险因素分析，采用受试者工作特征曲线（ROC曲线）确定风险指标预测界值。结果共37例（15.48%）急性缺血性卒中患者发生无症状深静脉血栓，经Logistic回归分析显示，入院时高水平血浆D-二聚体（OR=1.012，95% CI：1.011~1.013；P=0.000）为其重要危险因素。血浆D-二聚体对急性缺血性卒中无症状深静脉血栓形成的诊断界值为343 ng/ml，其灵敏度为0.784、特异度0.901，ROC曲线下面积为0.89 ±0.03（95% CI：0.846~0.929，P=0.000）。结论 D-二聚体是急性缺血性卒中患者无症状深静脉血栓形成的重要标志物，其水平升高是无症状深静脉血栓形成的潜在危险因素。

关键词: 卒中, 脑缺血, 静脉血栓形成, 下肢, 危险因素, Logistic模型

LI Wei, WANG Li-li, LI Hai-yan, FU Rui. Analysis of risk factors for asymptomatic deep venous thrombosis in patients with acute ischemic stroke[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(7): 592-597.

李巍, 王莉莉, 李海燕, 付睿. 急性缺血性卒中患者无症状深静脉血栓形成危险因素分析[J]. 中国现代神经疾病杂志, 2021, 21(7): 592-597.

/ / Recommend / Download Citations

URL: http://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2021.07.011

http://journal11.magtechjournal.com/cjcnn/EN/Y2021/V21/I7/592

References

[1] Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, Wang L, Jiang Y, Li Y, Wang Y, Chen Z, Wu S, Zhang Y, Wang D, Wang Y, Feigin VL; NESS-China Investigators. Prevalence, incidence, and mortality of stroke in China:results from a nationwide population-based survey of 480687 adults[J]. Circulation, 2017, 135:759-771.
[2] Wang D, Liu J, Liu M, Lu C, Brainin M, Zhang J. Patterns of stroke between university hospitals and nonuniversity hospitals in mainland China:prospective multicenter hospital-based registry study[J]. World Neurosurg, 2017, 98:258-265.
[3] Hao ZL, Liu M, Li W, Tan Y, Zhang YH, Wu LE, Zhao XL, Yang J, Wang QF, Tan S, Yang QW, Wu B, Wang LC. Basic characteristics and functional outcomes of 3123 consecutive patients in Chengdu stroke registry[J]. Zhonghua Shen Jing Ke Za Zhi, 2011, 44:826-831[.郝子龙, 刘鸣, 李伟, 谭燕, 张月辉,吴丽娥, 赵晓玲, 杨杰, 王清芳, 谈颂, 阳清伟, 吴波, 王丽春.成都卒中登记方法及3123例患者基本特征和功能结局[J].中华神经科杂志, 2011, 44:826-831.]
[4] Wang Z, Li J, Wang C, Yao X, Zhao X, Wang Y, Li H, Liu G, Wang A, Wang Y. Gender differences in 1-year clinical characteristics and outcomes after stroke:results from the China National Stroke Registry[J]. PLoS One, 2013, 8:e56459.
[5] Brandstater ME, Roth EJ, Siebens HC. Venous thromboembolism in stroke:literature review and implications for clinical practice[J]. Arch Phys Med Rehabil, 1992, 73(5-S):S379-391.
[6] Correction to:2018 guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2018, 49:e138.
[7] Sandercock PA, Counsell C, Kane EJ. Anticoagulants for acute ischaemic stroke[J]. Cochrane Database Syst Rev, 2015:IDCD000024.
[8] Wang Y, Shi Y, Dong Y, Dong Q, Ye T, Fang K. Clinical risk factors of asymptomatic deep venous thrombosis in patients with acute stroke[J]. Clin Appl Thromb Hemost, 2019, 25:1076029619868534.
[9] Stuck AK, Spirk D, Schaudt J, Kucher N. Risk assessment models for venous thromboembolism in acutely ill medical patients:a systematic review[J]. Thromb Haemost, 2017, 117:801-808.
[10] Liu LP, Zheng HG, Wang DZ, Wang YL, Hussain M, Sun HX, Wang AX, Zhao XQ, Dong KH, Wang CX, He W, Ning B, Wang YJ. Risk assessment of deep-vein thrombosis after acute stroke:a prospective study using clinical factors[J]. CNS Neurosci Ther, 2014, 20:403-410.
[11] Balogun IO, Roberts LN, Patel R, Pathansali R, Kalra L, Arya R. Clinical and laboratory predictors of deep vein thrombosis after acute stroke[J]. Thromb Res, 2016, 142:33-39.
[12] Li SY, Feng L, Xiao MJ, Chen SY, He JC, Wang Z. Derivation and validation of a clinical prediction scale for isolated distal deep venous thrombosis in patients after acute ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2017, 26:2087-2092.
[13] Neurology Branch of Chinese Medical Association, Cerebrovascular Disease Group of Neurology Branch of Chinese Medical Association. Diagnostic criteria of cerebrovascular diseases in China (version 2019)[J]. Zhonghua Shen Jing Ke Za Zhi, 2019, 52:710-715[.中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52:710-715.]
[14] Righini M, Le Gal G, Bounameaux H. Venous thromboembolism diagnosis:unresolved issues[J]. Thromb Haemost, 2015, 113:1184-1192.
[15] Xie WM, Wang C. The diagnosis ideas and treatment strategies of pulmonary thromboembolism:respiratory diseases (2)[J]. Xin Yi Xue, 2005, 36:547-548[.谢万木, 王辰. 肺血栓栓塞症的诊断思路与治疗策略——呼吸系统疾病(2)[J]. 新医学, 2005, 36:547-548.]
[16] Kong XL, Zhang X, Zhang SJ, Zhang L. Plasma level of D-dimer is an independent diagnostic biomarker for deep venous thrombosis in patients with ischemic stroke[J]. Curr Neurovasc Res, 2016, 13:100-106.
[17] Kelly J, Rudd A, Lewis RR, Parmar K, Moody A, Hunt BJ. The relationship between acute ischaemic stroke and plasma D-dimer levels in patients developing neither venous thromboembolism nor major intercurrent illness[J]. Blood Coagul Fibrinolysis, 2003, 14:639-645.

Please choose a citation manager

Content to export