Department of Neurology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
Department of Cardiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
BMC Neurol. 2024 Aug 26;24(1):295. doi: 10.1186/s12883-024-03802-0.
Deep vein thrombosis (DVT) is discussed as a source of embolism for cerebral ischemia in the presence of patent foramen ovale (PFO). However, previous studies reported varying rates of DVT in stroke patients, and recommendations for screening are lacking. This study aimed to characterize patients with stroke or transient ischemic attack (TIA) and concomitant PFO and explore the rate of DVT and associated parameters.
Medical records were screened for patients with stroke or TIA and echocardiographic evidence of PFO. Concomitant DVT was identified according to compression ultrasonography of the lower limbs. A variety of demographic, clinical, and laboratory parameters, the RoPE and Wells scores were compared between patients with and without DVT.
Three-hundred-thirty-nine patients (mean age 61.2 ± 15.4 years, 61.1% male) with stroke or TIA and PFO, treated between 01/2015 and 12/2020, were identified. Stroke and TIA patients did not differ for demographic and vascular risk factors. DVT was found in 17 cases out of 217 (7.8%) with compression ultrasonography. DVT was associated with a history of DVT, cancer, previous immobilization, calf compression pain, calf circumference difference, and a few laboratory abnormalities, e.g., increased D-dimer. A multivariate regression model with stepwise backward selection identified the Wells score (odds ratio 35.46, 95%-confidence interval 4.71-519.92) as a significant predictor for DVT.
DVT is present in a relevant proportion of patients with cerebral ischemia and PFO, which needs to be considered for the individual diagnostic workup. The Wells score seems suitable for guiding additional examinations, i.e., compression ultrasonography.
在卵圆孔未闭（PFO）存在的情况下，深静脉血栓（DVT）被认为是脑缺血的栓子来源。然而，先前的研究报告了中风患者中 DVT 的发生率不同，并且缺乏筛查建议。本研究旨在描述伴有 PFO 的中风或短暂性脑缺血发作（TIA）患者的特征，并探讨 DVT 的发生率和相关参数。
筛选出中风或 TIA 且经超声心动图证实存在 PFO 的患者的病历。根据下肢压缩超声检查确定是否存在并发 DVT。比较 DVT 患者与无 DVT 患者的各种人口统计学、临床和实验室参数、RoPE 和 Wells 评分。
共筛选出 339 例（平均年龄 61.2±15.4 岁，61.1%为男性）中风或 TIA 合并 PFO 的患者，这些患者于 2015 年 1 月至 2020 年 12 月间接受了治疗。在 217 例接受压缩超声检查的患者中，发现 17 例存在 DVT（7.8%）。DVT 与 DVT 病史、癌症、既往固定、小腿压缩痛、小腿周长差异和一些实验室异常（如 D-二聚体升高）有关。逐步向后选择的多元回归模型确定 Wells 评分（优势比 35.46，95%置信区间 4.71-519.92）是 DVT 的显著预测因子。
在患有脑缺血和 PFO 的患者中，DVT 的发生率较高，需要在个体诊断中考虑。Wells 评分似乎适合指导进一步检查，如压缩超声检查。
