As most of the participants of our daily team rounds are working in the Stroke Center, we return to a typical Stroke Unit topic today – DVTs in stroke patients. Using the (rare) example of a complicated DVT in the stroke unit, we cover the following issues:
- Clinical picture
With regard to the latter, there are some basic options:
- Do nothing (when is this allowed?)
- Give LMWH or Heparin
- Stockings (we don’t use them anymore since the Lancet 2009 paper)
- Intermittent pneumatic compression – we currently are trying to buy some of those gadgets
- Electrical stimulation (this is current research but might become a valuable option in the future)
- D-Dimer is a problem if you decide to follow-up on each pathological value. Yet it might help to identify cardioembolic strokes and might even increase the probability of pardoxic embolization in young patients. Thus I would not measure D-Dimer in every patient but young patients with small infarcts are a good population to screen.
- Many strokes have DVT even before their stroke (up to 7% if you believe this recent publication) and develop a few more during their stay
- Daily clinical examination of the legs are of the utmost importance.
- If in doubt, you can always grab our small ultrasound device and inspect the popliteal and inguinal veins, see whether they are compressible, if distal compression increases the flow and if respiratory variations persist in order to verify that the proximal and distal veins each are patent.