Analysis of risk factors for acute lower extremity deep vein thrombosis in patients with spontaneous intracerebral hemorrhage

Yu Yaya; Gao Ming; Xie Shengqiang; Yin Zhiyong; Han Chengchen; Wu Lin; Ma Xue; Sun Junzhao; Chang Hongbo

doi:10.11850/j.issn.1009-122X.2025.08.002

Abstract：Objective To investigate the risk factors for acute lower extremity deep vein thrombosis(ALDVT)in patients with spontaneous intracerebral hemorrhage(ICH).Methods The clinical data of 256 patients with spontaneous ICH were analyzed retrospectively,including etiology of hemorrhage,Glasgow Coma Scale(GCS)score,comorbid hypertension,diabetes mellitus,pulmonary infection,surgical treatment,history of limb venous thrombosis,newly developed ALDVT,affected limb muscle strength,D-dimer,blood glucose,fibrin degradation products(FDP),and ultrasound diagnostic results.Patients were divided into an ALDVT group and a non-ALDVT group based on the occurrence of new ALDVT.The incidence of ALDVT was calculated,and the treatment and prognosis after ALDVT occurrence were statistically analyzed.Univariate and multivariate logistic regression analyses were performed to explore potential risk factors for ALDVT.A nomogram prediction model was established,and its calibration performance was evaluated.Results Among the 256 patients with spontaneous ICH,aged 19-84 years(143 males and 113 females),the hospital stay ranged from 6 to 60 days.Abnormally elevated D-dimer levels were observed in 191 cases,and elevated FDP were noted in 187 cases.New ALDVT occurred in 82 cases(ALDVT group),with an incidence rate of 32.03％(82/256);174 cases were in the non-ALDVT group.In the ALDVT group,muscle strength in the affected limb was classified as grade 0 in 43 cases,grade Ⅰ in 16,grade Ⅱ in 12,grade Ⅲ in 8,grade Ⅳ in 2,and grade Ⅴ in 1.Multifactorial logistic regression analyses revealed that a GCS score≤8,comorbid diabetes,comorbid pulmonary infection,craniotomy surgery,history of venous thrombosis,muscle strength≤grade Ⅱ,and blood glucose≥10 mmol/L were risk factors for ALDVT(all P<0.05).Among the 82 ALDVT patients,63 received conservative drug treatment,17 underwent filter implantation surgery,and 2 received no treatment.Sixty-four patients experienced thrombus resolution and were discharged with improvement,resulting in a treatment effectiveness rate of 78.05％(64/82).Six patients had long-term lower extremity thrombosis,and 12 died(including 4 from pulmonary embolism).Based on the identified risk factors,a nomogram prediction model was constructed.The area under the curve(AUC)of the prediction model was 0.894(95％CI:0.848-0.933),indicating good predictive accuracy.The model also demonstrated high calibration(mean absolute error=0.005,C-index=0.897,Hosmer-Lemeshow P=0.73)and clinical utility.Conclusions Early monitoring of lower extremity venous ultrasound,D-dimer levels,and coagulation-related indicators in patients with spontaneous ICH,along with early active individualized intervention and enhanced nursing measures,can lead to favorable clinical outcomes for patients with ALDVT.