Abstract TP355: Rate of Deep Vein Thrombosis in Patients When Pharmacological DVT Prophylaxis is Delayed Due to IV tPA Use

Abstract

Introduction: Deep vein thrombosis (DVT) is associated with pulmonary embolism and reduced post stroke recovery. After thrombolysis, current US guidelines recommend a delay of 24 hours before initiation of pharmacological DVT prophylaxis. We sought to determine the rate of DVT in post-tPA patients with delayed pharmacological prophylaxis. Methods: Using GWTG stroke registry data from three large comprehensive stroke centers in the Northeast, South and West, we analyzed 13,420 consecutive stroke admissions from 02/2002 - 06/2018. Rates of DVT were compared between those with delayed prophylaxis due to post-tPA vs. all others. Chi-square was used for categorial data, T-Test for parametric continuous and Wilcoxon for non-parametric continuous variables. Multiple regression analysis (MV) was used to identify associations. Results: Of the 13,420 patients, 2974 (22.2%) received IV-tPA, 772 (5.8%) underwent EVT, 252 (1.9%) only EVT and 3279 (24.4%) received IV-tPA and/or EVT. There was a total of 536 (4.0%) patients with a documented DVT during the in-hospital stay. The rate of DVT in patients who received IV-tPA was significantly higher than in those who did not (4.6% vs 3.8%, p=0.036). Rates of DVT were 3.8% in patients not receiving tPA or EVT, 4.6% in IV tPA only group, 4.0% in EVT only group and 4.4% in IV tPA and/or EVT group. On univariate analysis Caucasian race, atrial fibrillation, smoking, weakness on presentation and use of IV tPA was significantly associated with DVT. On MV, only age, Caucasian race and a history of smoking was remained significantly associated with DVT. Conclusion: Although the NINDS tPA trial delayed DVT ppx initiation to 24 hrs, ECASS 3 allowed DVT ppx in post tPA patients without delay. Our analysis shows that post-thrombolysis patients with delayed DVT ppx had higher rates of DVT, although this effect did not remain significant on MV analysis. Larger studies to assess the safety of delaying DVT ppx in post tPA patients are warranted.