Objective:

To evaluate the yield of systematic lower extremity (LE) screening for deep venous thrombosis (DVT) in patients with hemorrhagic stroke (HS).

Background:

DVT is a serious complication in HS, with a reported incidence ranging from 2-40%, depending on patient selection.

Design/Methods:

We retrospectively analyzed 328 consecutive HS admissions between 09/2022 and 12/2024. As part of our quality improvement initiative, patients underwent LE Doppler ultrasound twice weekly, beginning within 24 hours of admission. We assessed DVT frequency and associated risk factors.

Results:

The cohort’s mean age (±SD) was 63±14 years and 53% were male. HS subtype included 74% intracerebral and 26% subarachnoid hemorrhage. LE Dopplers were performed in 311 (95%) patients and 79% of these were completed within 24 hours of admission. Most unscreened patients (70%) died within 24 hours. DVT was detected in 25 patients (8%), with 76% being above the knee, 24% being below the knee, and none being symptomatic. Among DVT cases, 86% were already receiving heparin prophylaxis when the DVT was identified and 24% were diagnosed within 24 hours. Five patients developed pulmonary embolism. All proximal DVTs were treated with anticoagulation or inferior vena cava filter. On bivariable analysis, DVT was more frequent in patients receiving opioids (16% vs. 4%, p=0.004) or requiring intubation at presentation (64% vs. 34%, p=0.002). DVT incidence, however, did not vary by HS severity scores or reversal agent use. In multivariable analysis, the composite of DVT and pulmonary embolism was associated with longer hospital stay (p=0.01) and higher rates of cerebral edema (p=0.004).

Conclusions:

The incidence of DVT in unselected cases of acute HS is 8%. Most DVTs are asymptomatic, and almost a quarter develop within 24 hours of admission. Our study supports the importance of early LE doppler screening in acute HS cases.