DVT prophylaxis in cerebral hemorhage

Zubkov AY, Wijdicks EFM Reviews in Neurological Diseases 2009; 6:21-25.

DVT occurs in 55 % of patients with acuts stroke and 5 % of early deaths in this group. Clinically apparent DVT occurs in 1.8 to 5 % of patients with ischemic stroke, subclinical in 28-73 %. In ICH, risk is similar; 15.9 % had DVT at 10 days among those wearing stockings. LE doppler is insensitive (misses many cases). 30 % of patients with PE do not show signs of lower extremity DVT. ACCP (2004) suggested mechanical means to prevent DVT, discouraged LMWH, and left heparin at discretion of practitioner. A meta-analysis in 2000 showed 45 % RR among neurosurgical patients receiving heparin. Only one RCT done shows 85 % reduction in DVT in heparinized patients (J Neurosurg 1978).