Factors Influencing Lower Extremity Deep Vein Thrombosis Risk and Prophylactic Approaches Following Intravenous Thrombolysis in Acute Ischemic Stroke Patients

Overview

This study identifies a significant association between the absence of early pharmacological thromboprophylaxis and the incidence of in-hospital DVT in acute ischemic stroke patients treated with intravenous thrombolysis. Key factors influencing the initiation of prophylaxis include atrial fibrillation, stroke severity, and elevated D-dimer levels.

Background

Acute ischemic stroke (AIS) is a leading cause of mortality and disability, with a high risk of venous thromboembolism (VTE) among affected patients. The use of intravenous thrombolysis (IVT) is critical in the hyperacute phase of AIS, yet it also increases the risk of complications such as lower extremity deep vein thrombosis (LEDVT). Understanding the factors that influence thromboprophylaxis is important.

Data Highlights

Key Findings

• Absence of early pharmacological thromboprophylaxis is associated with higher odds of in-hospital DVT.
• DVT occurred in 30.4% of patients without early prophylaxis compared to 6.8% with prophylaxis.
• Factors associated with non-initiation of early prophylaxis include atrial fibrillation and higher NIHSS scores.
• Patients with higher D-dimer levels were less likely to receive early prophylaxis.
• A risk-treatment paradox was observed, where patients at higher thrombotic risk received less prophylaxis.

Clinical Implications

Clinicians should be aware of the increased risk of DVT in AIS patients who do not receive early pharmacological prophylaxis.

Conclusion

The findings highlight a significant gap in thromboprophylaxis practices among AIS patients treated with IVT.

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7. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial - ScienceDirect
8. Guideline European Stroke Organisation (ESO) guidelines for prophylaxis for venous thromboembolism in immobile patients with acute ischaemic stroke
9. Incidence, Risk Factors, and Prevention of Deep Vein Thrombosis in Acute Ischemic Stroke Patients (IRIS-DVT Study): A Systematic Review and Meta-Analysis | MDPI
10. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association
11. Slide Set for 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke
12. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial - ScienceDirect
13. Guideline European Stroke Organisation (ESO) guidelines for prophylaxis for venous thromboembolism in immobile patients with acute ischaemic stroke
14. Incidence, Risk Factors, and Prevention of Deep Vein Thrombosis in Acute Ischemic Stroke Patients (IRIS-DVT Study): A Systematic Review and Meta-Analysis | MDPI