Khyber Teaching Hospital , Pakistan.
Title: Prophylaxis against deep venous thrombosis in stroke patients; really required?
He is working as a Registrar in Department of Medicine, Medical B Ward, Khyber Teaching Hospital, Peshawar- Pakistan.
Deep vein thrombosis is one of the complication in stroke patients. They are at high risk of deep vein thrombosis (DVT) because of immobility and increased prothrombotic activity. Depending on the diagnostic methods, DVT occurs in up to 80% of patients with ischemic stroke not receiving prophylactic therapy most often between days 2 and 7 after stroke onset; almost 80% of all DVTs occur within the first 10 days. DVT prevalence in Asian patients is much lower than other ethnic groups while prophylaxis through heparinization is sometimes associated with significant intracranial bleeds. The prevalence rate of DVT in hospitalized medically ill patients found at a Thai tertiary care hospital was only 5%.
Materials and methods
This study was conducted in Department of Medicine in collaboration with department of radiology at Khyber Teaching Hospital Peshawar from Jan 2016 to December 2016. Incidence of deep venous thrombosis was measured in ischemic stroke patients. All patients with ischemic stroke not receiving prophylactic heparin underwent Doppler studies of the lower limbs at day seven of stroke onset to look for development of any deep venous thrombosis.
Out of 114 stroke patients only one (0.88%) developed clinically significant deep venous thrombosis.
The incidence of DVT in stroke patients in Asian population is much lower to justify prophylactic heparin which has significant adverse clinical implications in the form of intracranial bleed as well as financial burden on patients in resource limited countries like Pakistan.