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Prognostic Importance of Hypercoagulability

Gianluca Landi, MD; Armando D'Angelo, MD; Edoardo Boccardi, MD; Livia Candelise, MD; Pier Mannuccio Mannucci, MD; Alberto Morabito, PhD; Eduardo Nobile Orazio, MD

Arch Neurol. 1992;49(3):279-283.

Abstract
• To assess the incidence, risk factors, and clinical importance of deep vein thrombosis in acute stroke, we studied 70 consecutive patients who underwent hemostasis screening at the time of entry into the study and followed up these patients with serial venous Doppler examinations and the iodine 125-labeled fibrinogen uptake test. Mortality was significantly higher among the 20 patients who developed a deep vein thrombosis, and eight of them had necropsy evidence of pulmonary embolism. Severity of leg paresis and a shortened activated partial thromboplastin time were significantly associated with subsequent deep vein thrombosis with multivariate analysis. Significantly higher levels of fibrinopeptide A were found in patients with postmortem evidence of pulmonary embolism. Deep vein thrombosis is a frequent complication of acute stroke and may influence the prognosis by inducing pulmonary embolism. Our findings allow rapid identification of high-risk patients who may benefit maximally from prophylactic treatment of venous thromboembolism.

Author Affiliations
From the Neurological Clinic II, Ospedale Maggiore and the University of Milan (Italy) (Drs Landi, Candelise, and Nobile Orazio); the A. Bianchi Bonomi Hemophilia and Thrombosis Center and Institute of Internal Medicine, University of Milan (Drs D'Angelo and Mannucci); the Department of Neuroradiology, Ospedale Niguarda, Milan (Dr Boccardi); and the Institute of Medical Statistics and Biometry, University of Milan (Prof Morabito).

Footnotes
Accepted for publication August 1, 1991.

Reprint requests to the Clinica Neurologica, Ospedale Policlinico, Via F. Sforza 35, 20122 Milano, Italy (Dr Landi).

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