In our acute stroke care center, we sometimes encounter problems of deep vein thrombosis (DVT), a problem that has been increasing in recent years. There is presently consensus regarding the treatment for urgent cases of DVT, but there is no established policy regarding non-urgent cases. We reviewed the therapeutic courses of the three cases (of which two were symptomatic and the other asymptomatic) in which the stroke patients had a complication of DVT in our facility.
The first case was a 61-year-old male, who developed atherothrombotic stroke and was administered with intravenous treatment with tissue plasminogen activator. During the course, the patient was found out to have pain and swelling in the paralyzed lower leg. DVT was found, and anticoagulant treatment was administered, followed by inferior-vena-cava (IVC) filter detention. The second case was a 79-year-old female, who developed atherothrombotic stroke and was administered with anti-coagulant treatment. Respiratory discomfort was observed, and a detailed examination revealed she had a complication of pulmonary embolism (PE) and DVT. After the immediate IVC filter detention, additional anticoagulant treatment was administered. The third case was an 81-year-old male who underwent conservative treatment for brain hemorrhage. D-dimer rose during the course, and a detailed examination revealed a thrombus in the pulmonary artery and the vein in the paralyzed leg. Although he had no symptoms, elastic stockings were used to prevent PE, and anticoagulant treatment was administered.
DVT has been reported about 10 percent of the patients hospitalized in rehabilitation hospitals, and it is important to detect asymptomatic DVT in stroke patients with paralysis at an early stage. Urgent cases in which PE and symptoms in lower legs are observed can be treated with IVC filter and catheter, for example. But asymptomatic DVT often goes unnoticed, and there is no consensus on its treatment. We suggest that anticoagulant treatment and the use of elastic stockings are effective in treating DVT.