Deep vein thrombosis: Prevalence and risk factors in rehabilitation admissions with brain injury

• Published in: Neurology Vol. 63; no. 3; pp. 485 - 491
• Main Authors: YABLON, S. A, ROCK, W. A, NICK, T. G, SHERER, M, MCGRATH, C. M, GOODSON, K. H
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 10-08-2004
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Brain Injuries - complications; Brain Injuries - rehabilitation; Brain Neoplasms - complications; Brain Neoplasms - rehabilitation; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - rehabilitation; Female; Fibrin Fibrinogen Degradation Products - analysis; Humans; Hypoxia, Brain - complications; Hypoxia, Brain - rehabilitation; Leg - blood supply; Leg - diagnostic imaging; Male; Medical sciences; Middle Aged; Neurology; Prospective Studies; Risk Factors; Thrombophilia - complications; Ultrasonography, Doppler, Duplex; Venous Thrombosis - blood; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - epidemiology; Venous Thrombosis - etiology; Vascular disease; Nervous system diseases; Prevalence; Central nervous system; Risk factor; Cardiovascular disease; Deep vein; Rehabilitation; Epidemiology; Thrombosis; Encephalon
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/01.WNL.0000133009.24727.9F

To determine the prevalence and risk factors of deep vein thrombosis (DVT) among neurorehabilitation admissions with acquired brain injury (BI).
In this prospective, sequential case series, 709 consecutive initial neurorehabilitation patients with BI < 120 days-including traumatic brain injury (TBI; n = 360), intracranial hemorrhage (ICH; n = 213), primary brain tumor (n = 66), and hypoxia/other BI (n = 70)--were screened for evidence of DVT with lower extremity venous duplex ultrasonography (VDU). The admission screening protocol combined VDU and a commercial d-dimer (Dimertest [DDLx]) latex agglutination assay. DVT was considered present based upon VDU results only.
DVT prevalence was 11.1%, and was higher with brain tumor (21.2%) and ICH (16%) than with TBI (6.7%) (chi2 test; p = 0.001). DVT risk factors identified by multivariable logistic regression analysis in the overall sample included older age (p = 0.002), type of BI (p = 0.04), DDLx (p = 0.0001), and greater postinjury duration (p = 0.0001), with a trend observed regarding lower Functional Independence Measure (FIM) locomotion (FIM-Loco) subscale score (p = 0.07). However, risk factors also varied with type of BI. Among patients with TBI, only DDLx (p = 0.001) and greater postinjury duration (p = 0.001) were associated with DVT.
Admission venous duplex ultrasonography revealed occult proximal lower extremity deep vein thrombosis in 11% of neurorehabilitation patients with acquired brain injury. Deep vein thrombosis risk is multifactorial in this heterogenous patient population, with relative factor risk influenced by type of acquired brain injury. Semiquantitative d-dimer latex agglutination assay correlated significantly with presence of deep vein thrombosis.