Abstract WP287: Screening Venous Ultrasound For Asymptomatic Lower Extremities Deep Venous Thrombosis In Acute Stroke Patients: Will It Change Management Strategies?

Abstract

INTRODUCTION: Deep venous thromboses in stroke patients are often asymptomatic. There is limited support that screening for asymptomatic lower extremities DVT with venous duplex ultrasound changes clinicians’ management of stroke patients. Hypothesis: We hypothesized that the detection of asymptomatic deep venous thrombosis in acute stroke patients would result in changes or intensification of anticoagulation management strategies. Methods: We performed a retrospective chart review of all strokes (ischemic and hemorrhagic), orthopedic surgery, and trauma patients admitted to our Acute Rehabilitation Unit (ARU) between January 2004 and December 2009. We selected out all stroke patients and recorded those as asymptomatic DVT if there was no documentation of signs or symptoms for DVT by the primary provider within 48 hours prior to obtaining a lower extremity venous ultrasound. A change in anticoagulation management was noted if any addition or change to the patient’s admitting anticoagulation intervention. Results: There were 909 patients admitted to our ARU. Of those patients, 78 patients were diagnosed with an asymptomatic lower extremity DVT prior to transfer to the ARU. Strokes patients accounted for 34 (43.5%) of these 78 patients. All of the stroke patients were under the care of a neurology team. A majority of the lower extremity DVT among the stroke patients were considered acute (N=30;88.2%) and 21% (N=7) had bilateral, acute DVT. Most of the stroke patients received DVT prophylaxis on admission (N=26;76.4%). After diagnosis of an acute DVT, clinicians changed their management strategies in 65% of cases, whereas in 23.5% of cases there were no changes. Among the changes in management, 50% of patients (11/22;50%) were started or had an escalation in anticoagulation treatment. Interrupted venal cava filter was placed in 5 patients and serial venous ultrasound surveillance was used for 7 patients. Conclusions: This study shows that the detection of an acute asymptomatic lower extremity DVT in stroke patients resulted in anticoagulation management strategies changes for most stroke patients. It also supports the need to perform screening venous ultrasound on all acute stroke patients.