The timing, extent, progression and regression of deep vein thrombosis in immobile stroke patients: observational data from the CLOTS multicenter randomized trials

M Dennis; N Mordi; C Graham; P Sandercock; CLOTS trials collaboration

doi:10.1111/j.1538-7836.2011.04486.x

The timing, extent, progression and regression of deep vein thrombosis in immobile stroke patients: observational data from the CLOTS multicenter randomized trials

J Thromb Haemost. 2011 Nov;9(11):2193-200. doi: 10.1111/j.1538-7836.2011.04486.x.

Authors

M Dennis¹, N Mordi, C Graham, P Sandercock; CLOTS trials collaboration

Collaborators

CLOTS trials collaboration:
M Dennis, G Cranswick, A Deary, A Fraser, C Graham, S Grant, A Gunkel, J Hunter, A MacRae, D Perry, V Soosay, C Williams, A Williamson, A Young, P A G Sandercock, J Reid, C Graham, G Murray, G Venables, A Rudd, G Bowler, G Cranswick, S Lewis, G Celani, S Ricci, R Lindley, M Hautvast, M Paterson, T Ting, C Baigent, J Bamford, J Slattery, A Claxton, G Hankey, P Boers, R Millar, A Royan, M Russell, N Beydoun, M Romerosa, G Gubitz, J Jarrett, K Legg, M MacKay, S Nearing, S Phillips, E Ehler, P Geier, M Mrklovsky, A M Anandan, G Kusumakar, J Rosario, A K Roy, M Crowe, I Noone, C Duffy, E Farrelly, M Jadrnickova, L Masterson, J Morris, S Murphy, V Bondo, D Capecchi, M G Celani, S Cupella, L Guerra, A Macchitella, C Ottaviani, E Righetti, C Rossi, M G Scucchi, V Stefanini, A Tufi, A Barilaro, S Cenciarelli, S Dioguardi, E Gallinella, L Greco, A Mattioni, T Mazzoli, S Ricci, S Chiarandini, F Chiodo Grand, B Ziani, L Zugna, A Fancello, L D Parish, P Pileri, M Pinna, M P Piras, A Pirisi, C Scodino, M L Zedde, M Rasura, S Ospedale Giovanni Battista, Foligno Perugia, S Stefanucci, G S Grasselli, G Procaccianti, A Segni, P Beccu, A Del Rio, M Fresu, A Musselli, A Pala, S Traccis, G Martino, M R Musolino, A Leyva, P Canhão, F Falcão, T P Melo, J Coyle, C Croser, C Rhymes, E Barrie, L Birkhead, A Burinski, M Davisdon, A Denham, T Flanninigan, S Ghosh, J Given, M Gormanely, K Hockings, C Hutton, K Kerr, J McCall, P McLaren, L McLean, R McNeil, M Middleton, A Reid, C Somerville, E Todd, C Wallace, C Wells, K Whyte, M K Al Bazzaz, K Elliott, K Hawley, L Smith, N Beacham, C Buckley, S Bulley, D Gibbons, L Jones, C Lawson, S More, K Rashed, S Savage, R Miller, C Roffe, P Acheampong, M Bruce, M J Macleod, J McCormack, R Shinton, K Ali, J Breeds, C Rajkumar, S Walker, C Barker, A Buchan, A Flowers, R Hanna, J Hinkle, J Kennedy, G Littlejohn, C Mayell, A McCulloch, R Teal, H Tinamisan, S Webster, M Westwood, P Davies, C Walker, V Baliga, E Brown, L Burnside, S Clayton, A Mehrzad, M Adrian, P Bath, J Clarke, F Hammonds, K Adie, R Bland, G Courtauld, F Harrington, A James, A Mate, C Schofield, C Wroath, P Bailey, D French, K Jackson, S G Ramsay, L Spence, G Fletcher, C Kearns, S Lohara, K Darawil, E Brown, C Church, P Earnshaw, S Hunter, E Roberts, C Draper, J Harris, J Okwera, P Guyler, C Khuoge, A O'Brien, A Davis, M Fitzpatrick, L Kalra, R Pathansali, C Potter, G Abbott, K Chatterjee, C Kelly, H Aitken, J Barrett, V Gott, A Lenfesty, V Little, D Lowe, G Sangster, P Weir, K Ayes, H Crockatt, P Das, P Lai, L Lavelle, N Peacock, F Dick, M MacLeod, R Brown, S Leach, A Bell, C Boyden, L Corrigan, C Curley, J Howard, K Kawafi, H Brew, E Brown, C Church, P Earnshaw, J Foster, D Gulliver, D Hindmarsh, S Hunter, J O'Connell, M Reddick, E Roberts, N Betts, D K Chadha, L Holford, J Sayles, J Cooper, A Hassan, M Keeling, P Wanklyn, H Wild, E Hakim, U Sinclair, S Boland, S Brotheridge, J Crabtree, C Hare, S Lee, J Strover, G Whil, L White, L Bury, J Hodgson, N Murray, P Rana, G Seebass, I Shakir, C Whitworth, R Sykes-Elwers, C Brown, P Dobson, B Hyams, L March, A Mohd Nor, J Atherton, E Bacabac, R Durairaj, R Kumar, M Kuofali, H Martin, A Sharma, V Sutton, M Aslam, R Brown, S Duffy, A Hardwick, J Hull, S Leach, C Logan, H Maltby, D Mangion, A Palmer, T Smith, M Adamson, W E Barrett, H Gange, A Gonzalez, C Gould, S Heaton, L Le Blanc, S Panchalingam, G Pope, P K Tun, A van Wyk, A Amorim, J Chataway, R Browne, S Dealing, D Meek, T Smith, I Green, L Johnston, K Lomas, S Maguire, C Patterson, S Riley, S Williamson, L Dacey, R Navaratnasingam, M Wani, J Ashcroft, L Caudwell, M Farrar, S Gillam, M Hanley, M Hussain, R Larkham, R Norris, A McSorley, M Matthews, M Power, R Wright, L Butler, C Davison, M Fairhurst, M Horner, F Hussain, C Loughran, M Sein, D Walker, M Cottle, D Collas, P Jacob, G Dunn, A Jones, B Chapman, A Cormack, A Coull, S Hart, G Mead, B Morrow, D Bruce, S Crawford, J Barber, A Ingham, C Levick, B Simpson, J Stevens, L Swindells, P Tyrrell, J Wainwright, T Whittle, J McIlmoyle, M J O'Donnell, J Howard, H Goddard, S Duberley, S Punekar, M Ellis, H Jenkins, P Sharma, J Slark, N Wilson, O David, D Jenkinson, J Kwan, A Orpen, C Ovington, P Ray, S Thelwel, C Jenkins, J Powell, J Smith, H Bennett, M Downing, R Fulcher, P McCarthy, K Metcalf, N Wyatt, A Atkinson, P Bond, D Broughton, I Tullo, J Frazer, L Haslop, R Jolly, E Lavery, O Orugun, J Starkey, A Young, N Brain, R Donnelley, P Gorman, K McLean, K Muhidden, C Roe, F Ryan, N Palin, G Powell, R Wells, E Wright, L Abey-Koch, V Davis, K O'Brien, L Shaw, A Catto, D Karanwal, K Lindsay, S Mawer, C Orgles, K Smith, K Spence, M White, S Williamson, E Giallombardo, N Roberts, B Mherjee, P Tari, G Gunathilagan, J Idris, S A Jones, D G Smithard, G Thomas, S Johnston, M Stirling, V Bassan, M Brown, O Browne, L Deans, K Elfandi, D Greenway, J McCormack, S Stafford, J Horsley, R Lawrence, O Khan, S Mountford, F Baig, D Bates, H Brown, K Cool, L Ijewsky, J Long, U Sinha, K Crilly, E Friedman, P Gompertz, K Kee, E Klaasen, T Sachs, M Stoneman, K Upton, T Waters, D E McCreery, H G M Shetty, L F Smith, M Badanhatti, J Cobb, R Curless, J Dickson, K Greenwell, C Price, H Rodgers, M Sudlow, M Patel, M Ball, J Sharma, G Subramanian, L Swart, M Ball, A Marsh, A Oldfield, S Potter, S Punnoose, P Rose, T Vaughn, J Chambers, N Devitt, H Dymond, F Henchie, C Ramsey, G Saunders, E Caldwell, C Long, H Ramsay, M J Wrigley, J Anthony, A Boynes, R Clough, C Colabella, J Collins, K Godson, A McGuiness, K Malinder, A Needle, S Robertshaw, A Sharp, D Skelton, A Stanners, S Tempest, T White, J Wiehl, H Wilkins, T Donlan, S Herath, N Chapman, K McCormick, A Abdul-Hamid, J Greig, P Parker, R Rayessa, E Jones, K Law, D Sims, R Graham, P Langhorne, D Stott, M Shields, F Wright, K Crook, E A Freeman, C Watkins, S Caine, J Egbuji, K Hotchkiss, A M Lappin, J A Graham, J Scott, K Law, P Sanmuganathan, E Stratford, U Ahmed, B Simpson, A Brown, S Haines, M Mckay, A McLaren, J Reid, F Kelly, G E Gamble, S J Welsh, I Wiggam, L Butler, P Ghosh, C O'Brien, I M Anwar, S Crawford, P Fraser, R Graham, C McAlpine, M Shields, F Asare, H Audebert, S Banfield, J Birns, G Cluckie, N Iles, J Leon, A Reindorf, O Roncale, A Roots, A G Rudd, R Sankoh, V Scott, N Smyth, K Muhidden, P Thornton, S Jamieson, J Paterson, R Rose, G Jutlla, S Ramkumar, L Sekaran, S Sethuraman, B Clamp, A Oke, J Robson, A Wright, L Campbell, P Findlay, K Butchard, R Farag, J Cronan, L Harris, D Walters, L Cowie, D G Smithard, A Conrad, N Cornford, J Gallagher, F Kirrage, A Mason, M Dennis, E Eadie, S Keir, L Smith, P Taylor, A Thomas, J Wardlaw, H S Baht, C Collins, H Hamilton, F Johnson, S Reilly, K Smeaton, J Blackwell, V Umachandran, M Dobbin, E Feeley, L Forsyth, F Gardner, B MacInnes, B Martin, C Stirling, B Yip, D Kelly, S Szabo, V Cannon, T Chambers, D Dutta, K Harvey, V Wager, G Ward

Affiliation

¹ Division of Clinical Neurosciences, Western General Hospital, University of Edinburgh, Edinburgh, UK. martin.dennis@ed.ac.uk

PMID: 21883879
DOI: 10.1111/j.1538-7836.2011.04486.x

Abstract

Background: Deep vein thrombosis (DVT) is an important complication of stroke, but the evidence to support commonly used prophylactic strategies is conflicting.

Objectives: To describe the incidence, extent, associated clinical features and evolution of DVT after stroke.

Patients/methods: The CLOTS trials 1 and 2 together randomized 5632 immobile stroke patients in 135 hospitals in nine countries. We screened patients for asymptomatic DVT with compression duplex ultrasound (CDU) at about 7-10 days and again at about 25-30 days after enrollment.

Results: Six hundred and forty-one (11.4%) of 5632 patients had DVT detected on the first CDU scan at a median of 8 days (interquartile range [IQR] 7-10 days) after enrollment, and an additional 176 (3.1%) had a DVT on the second CDU scan at a median of 28 days (IQR 26-30 days). Of the 817 with DVTs, 289 (35%) were symptomatic and 39 (5%) had pulmonary embolism (PE) confirmed by imaging. Six hundred and seventy-six (83%) were unilateral, 141 (17%) were bilateral, 322 (39%) were limited to calf veins, 172 (21%) were popliteal, and 323 (40%) were femoral. Among the 542 patients with DVT and a weak leg, the DVT affected the weaker leg in 396 (73%), the stronger leg in 59 (11%), and was bilateral in 87 (16%). Among the 318 patients with a DVT detected on the first CDU scan who had a second scan, the DVT regressed in 148 (47%), stayed the same in 140 (44%), and progressed in only 30 (9%).

Conclusions: Although most DVTs develop within the first week, some develop later, and some early DVTs progress. Any prophylaxis needs to be started early but ideally continued for at least 4 weeks.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Aged
Aged, 80 and over
Disease Progression
Female
Humans
Incidence
Leg / physiopathology
Male
Premedication
Pulmonary Embolism / etiology
Stroke / complications*
Stroke / epidemiology
Time Factors
Venous Thrombosis / epidemiology*
Venous Thrombosis / etiology
Venous Thrombosis / pathology*

Abstract

Publication types

MeSH terms

Grants and funding