Deep vein thrombosis in stroke patients admitted to a rehabilitation unit in Singapore

Background: Studies have shown that deep vein thrombosis (DVT) is common after an acute stroke. Less common are studies documenting DVT in stroke patients admitted to rehabilitation. The purpose of this study was to determine the frequency and risk factors of DVT in stroke patients admitted to a rehabilitation unit in Singapore. Methods: A prospective observational single-center study of patients with ischemic and hemorrhagic stroke with lower limb paresis admitted to a rehabilitation center in Singapore. The screening protocol consisted of quantitative D-dimer assay (DDA) within 24-48h of rehabilitation admission followed by duplex ultrasound scan of the paretic lower extremity if DDA level was elevated (equal or greater than 0.34 μg/ml). Results: Altogether, 341 patients were screened at a mean of23 days poststroke. One hundred and ninety-eight (58.1%) patients had an elevated DDA and all underwent ultrasound scans. The frequency of lower limb DVT was 9% (18) - seven proximal and 11 distal. DVT was significantly related to higher D-dimer levels (P = 0.029) and cortical strokes (P = 0.004), but not to age, gender, race, nature of stroke, atrial fibrillation, severity of lower limb weakness, and ambulatory and functional status. No patients had clinical pulmonary embolism during rehabilitation. Conclusions: Lower limb DVT is uncommon in stroke patients admitted to rehabilitation in Singapore. Future research should include evaluation of the cost-effectiveness of such a screening protocol.