Routine surveillance of pelvic and lower extremity deep vein thrombosis in stroke patients with patent foramen ovale
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Routine surveillance of pelvic and lower extremity deep vein thrombosis in stroke patients with patent foramen ovale Sophie Samuel1 · Sujan T. Reddy2 · Kaushik N. Parsha2 · Thuy Nguyen1 · Hari Kishan Reddy Indupuru2 · Anjail Z. Sharrief2 · Liang Zhu3 · Louise D. McCullough4 · Sean I. Savitz2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Patent foramen ovale (PFO) is a potential conduit for paradoxical embolization to the systemic atrial circulation of a thrombus originating in the venous system. In a selected group of subjects, the prevalence of deep vein thrombosis (DVT) was assessed. Subjects were identified if they underwent magnetic resonance venography (MRV) pelvis and lower extremity doppler (LE-VDU) for assessment of DVT with PFO. The primary outcome measure was to report the number of patients with paradoxical embolization as their suspected etiology of stroke due to the presence of DVT, which then will be considered as determined stroke. Others with determined stroke diagnosis were reported using Treatment of Acute Stroke Trial (TOAST) criteria. At discharge, those without etiology of their stroke were grouped under embolic stroke of undetermined source (ESUS). We further analyzed the prevalence of DVT by age group, ≤ 60 years vs > 60 years to describe if the prevalence is higher with younger age and to evaluate if higher Risk of Paradoxical Embolism (ROPE) score will have higher number of DVTs compared to lower ROPE scores. Of the 293, 19 (7%) were strokes due to paradoxical embolism. At discharge, determined stroke were 54% vs ESUS were 46%. The overall prevalence of DVT was 19 (7%); MRV-pelvis 13 (4%), and LEVDU was 9 (3%). No significant difference was noted using both modalities. However, in multivariable regression analysis, a trend suggested an association between pelvic thrombi and high ROPE score as the etiology of stroke; OR 3.56 (0.98, 12.93); p = 0.054. Detection of DVT was not associated with PFO, high ROPE scores or young age. Our data indicate an over-reliance of testing for DVT, particularly MRV pelvis with contrast, in patients with PFO. Clinical studies are needed to identify other factors predictive of DVT in patients with ischemic stroke and PFO. Keywords Ischemic stroke · ESUS · Determined stroke · DVT · Pelvic thrombi · MRV-pelvis
Highlights • Prevalence of DVT was assessed in patients with
ischemic stroke and PFO.
* Sophie Samuel [email protected] 1
Neuroscience Intensive Care Unit, Department of Pharmacy, Memorial Hermann - Texas Medical Center, 6411 Fannin Street, Houston, TX 77030, USA
2
Institute for Stroke and Cerebrovascular Disease, The University of Texas McGovern Medical School, Houston, TX, USA
3
Internal Medicine, The University of Texas McGovern Medical School, Houston, TX, USA
4
Vascular Neurology, The University of Texas McGovern Medical School, Houston, TX, USA
• Estimated prevalence of DVT in patients with ischemic
stroke and PFO was 7% of the study population.
• Prevalence of pelvic thrombi in p
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