Yonsei Med J.  2016 Mar;57(2):388-392. 10.3349/ymj.2016.57.2.388.

Deep Vein Thrombosis in the Lower Extremities in Comatose Elderly Patients with Acute Neurological Diseases

• Yamada SM
• Tomita Y
• Murakami H
• Nakane M

• KMID: 2374044
• DOI: http://doi.org/10.3349/ymj.2016.57.2.388

Abstract

PURPOSE
Comatose elderly patients with acute neurological illness have a great risk of deep vein thrombosis (DVT). In this study, the incidence of DVT and the effectiveness of early initiation of treatment were evaluated in those patients.
MATERIALS AND METHODS
Total 323 patients were admitted to our ward due to neurological diseases in one year, and 43 patients, whose Glasgow Coma Scale was < or =11 and who was older than > or =60 years, were included in this study. D-dimer was measured on admission and day 7, and lower-extremity ultrasonography was performed on day 7. When DVT was positive, heparin treatment was initiated, and further evaluation of pulmonary embolism (PE) was conducted. Vena cava filter protection was inserted in PE-positive patients. Incidence of DVT and PE, alteration of D-dimer value, and effect of heparin treatment were analyzed.
RESULTS
DVT was positive in 19 (44.2%) patients, and PE was in 4 (9.3%). D-dimer was significantly higher in DVT-positive group on day 7 (p<0.01). No DVT were identified in patients with ischemic disease, while 66.7% of intracerebral hemorrhage and 53.3% of brain contusion patients were DVT positive. Surgery was a definite risk factor for DVT, with an odds ratio of 5.25. DVT and PE disappeared by treatment in all cases, and no patients were succumbed to the thrombosis.
CONCLUSION
Patients with hemorrhagic diseases or who undergo operation possess high risk of DVT, and initiation of heparin treatment in 7 days after admission is an effective prophylaxis for DVT in comatose elderly patients without causing bleeding.

Keyword

Deep vein thrombosis; D-dimer; elderly; heparin; pulmonary embolism

MeSH Terms

Acute Disease
Aged
Anticoagulants/adverse effects/therapeutic use
Antifibrinolytic Agents/therapeutic use
*Coma
Female
Fibrin Fibrinogen Degradation Products/therapeutic use
Hemorrhage/*epidemiology
Heparin/adverse effects/therapeutic use
Humans
Incidence
Japan/epidemiology
Lower Extremity
Male
Middle Aged
Nervous System Diseases/epidemiology
Neurosurgical Procedures/*adverse effects
Pulmonary Embolism/*complications/epidemiology/prevention & control
Risk Factors
Venous Thrombosis/epidemiology/*etiology/prevention & control
Anticoagulants
Antifibrinolytic Agents
Fibrin Fibrinogen Degradation Products
Heparin

Figure

• 

  Fig. 1 Flow chart of admitted patients for study. Flow chart shows patient recruitment, examination, and treatment.

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