Division of Clinical Neurosciences, Western General Hospital, University of Edinburgh, Edinburgh, UK.
J Thromb Haemost. 2011 Nov;9(11):2193-200. doi: 10.1111/j.1538-7836.2011.04486.x.
Deep vein thrombosis (DVT) is an important complication of stroke, but the evidence to support commonly used prophylactic strategies is conflicting.
To describe the incidence, extent, associated clinical features and evolution of DVT after stroke.
PATIENTS/METHODS: The CLOTS trials 1 and 2 together randomized 5632 immobile stroke patients in 135 hospitals in nine countries. We screened patients for asymptomatic DVT with compression duplex ultrasound (CDU) at about 7-10 days and again at about 25-30 days after enrollment.
Six hundred and forty-one (11.4%) of 5632 patients had DVT detected on the first CDU scan at a median of 8 days (interquartile range [IQR] 7-10 days) after enrollment, and an additional 176 (3.1%) had a DVT on the second CDU scan at a median of 28 days (IQR 26-30 days). Of the 817 with DVTs, 289 (35%) were symptomatic and 39 (5%) had pulmonary embolism (PE) confirmed by imaging. Six hundred and seventy-six (83%) were unilateral, 141 (17%) were bilateral, 322 (39%) were limited to calf veins, 172 (21%) were popliteal, and 323 (40%) were femoral. Among the 542 patients with DVT and a weak leg, the DVT affected the weaker leg in 396 (73%), the stronger leg in 59 (11%), and was bilateral in 87 (16%). Among the 318 patients with a DVT detected on the first CDU scan who had a second scan, the DVT regressed in 148 (47%), stayed the same in 140 (44%), and progressed in only 30 (9%).
Although most DVTs develop within the first week, some develop later, and some early DVTs progress. Any prophylaxis needs to be started early but ideally continued for at least 4 weeks.
深静脉血栓（DVT）是中风的一个重要并发症，但支持常用预防策略的证据存在冲突。
描述中风后 DVT 的发生率、程度、相关临床特征和演变。
患者/方法：CLOTS 试验 1 和 2 共纳入了 9 个国家 135 家医院的 5632 名不能活动的中风患者。我们使用压缩双功超声（CDU）在入组后约 7-10 天和 25-30 天对无症状 DVT 进行筛查。
5632 例患者中有 641 例（11.4%）在 CDU 首次扫描时检测到 DVT，中位数为入组后 8 天（四分位距 [IQR] 7-10 天），另外 176 例（3.1%）在 CDU 第二次扫描时检测到 DVT，中位数为 28 天（IQR 26-30 天）。817 例 DVT 中，289 例（35%）有症状，39 例（5%）有影像学证实的肺栓塞（PE）。676 例（83%）为单侧，141 例（17%）为双侧，322 例（39%）局限于小腿静脉，172 例（21%）为腘静脉，323 例（40%）为股静脉。542 例 DVT 伴下肢无力患者中，DVT 影响弱侧肢体 396 例（73%），影响强侧肢体 59 例（11%），双侧肢体 87 例（16%）。在首次 CDU 扫描发现 DVT 的 318 例患者中，148 例（47%）DVT 消退，140 例（44%）DVT 不变，仅 30 例（9%）DVT 进展。
尽管大多数 DVT 在第 1 周内发展，但有些 DVT 发展较晚，有些早期 DVT 进展。任何预防措施都需要尽早开始，但最好至少持续 4 周。
