Risk of Venous Thromboembolism in Patients with Large Hemispheric Infarction Undergoing Decompressive Hemicraniectomy

Nohra Chalouhi, Badih Daou, Fred Rincon, Maria Montano, Anthony Kent, Kaitlyn Barkley, Robert M. Starke, Stavropoula Tjoumakaris, David Hasan, Richard Dalyai, Robert Rosenwasser, Pascal Jabbour

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Deep-venous thrombosis (DVT) and pulmonary embolism (PE) are major causes of morbidity and mortality in patients with acute ischemic stroke. This study is the first to examine the risk of venous thromboembolism in patients with large hemispheric infarction undergoing decompressive hemicraniectomy. Methods: The study population included 95 consecutive patients with a large hemispheric infarction who underwent decompressive hemicraniectomy between 2006 and 2014 at our institution. All patients received prophylactic unfractionated heparin and intermittent compression devices (SCD). Patients were systematically screened for DVT at 5-day interval using Duplex ultrasound. PE was diagnosed on chest CT angiography. Results: Mean age was 57 ± 12 years; mean BMI was 28.3 ± 7.4 kg/m2. 30.5 % of patients had infarction in the dominant hemisphere and 69.5 % in the non-dominant hemisphere. The mean NIHSS score was 16.0 ± 5 at admission. The mean length of stay was 22 ± 17 days. 35 % of patients developed a DVT including 27 % who developed above-knee DVT and required placement of an inferior vena cava filter. In multivariable analysis, predictors of DVT were an NIHSS ≥ 17 (p = 0.007), seizures (p = 0.003), hypertension (p = 0.03), and increasing length of stay (p = 0.01). The proportion of patients who developed PE was 13 %. In multivariate analysis, BMI ≥ 30 predicted PE (p = 0.05). Conclusions: The rate of DVT and PE is remarkably high in patients with large hemispheric infarction undergoing decompressive hemicraniectomy despite prophylactic measures. We recommend routine screening for DVT in this population. Interventions beyond the standard prophylactic measures may be necessary in this high-risk group.

Original languageEnglish (US)
Pages (from-to)105-109
Number of pages5
JournalNeurocritical Care
Volume25
Issue number1
DOIs
StatePublished - Aug 1 2016
Externally publishedYes

Keywords

  • Decompressive hemicraniectomy
  • Stroke
  • Venous thromboembolism

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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