Deep Vein Thrombosis and Pulmonary Embolism following Hemorrhagic Stroke

Abstract

Corresponding Author: Sung Ho Lee, M.D., Ph.D. Department of Neurosurgery, School of Medicine, Kyung Hee University, 23 Kyung Hee Dae Ro, Dongdaemoon-gu, Seoul 02447, Korea Tel: +82-2-958-8385 Fax: +82-2-958-8380 Email:nslsh@khu.ac.kr; nooname79@gmail.com Venous thromboembolism (VTE) after stroke is an infrequent but potentially fatal medical complication. The incidence of VTE was shown to be higher in hemorrhagic stroke than in ischemic stroke by several studies; however, no strategy for VTE screening and prophylaxis has been established. Lower extremity ultrasonography (US) is the diagnostic method of choice, but routine application for stroke patients is still debated. For prevention, graduated compression stockings (GCS) have little effect on VTE, and thigh-high GCS should be selected. Early use of intermittent pneumatic compression (IPC) has strong evidence for preventing VTE and is recommended in several clinical guidelines for managing intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Prophylactic heparin products are still debated for preventing VTE despite the risk of rebleeding or hematoma enlargement. To date, administering low-dose, low-molecular-weight heparin (LMWH) seems the best method to prevent VTE with less risk of hemorrhagic complications. However, the optimal product, dose, and timing are unclear.