出血性脳卒中における深部静脈血栓症とDダイマー値の関連性

Association of Deep Venous Thrombosis with D-dimer Values in Patients with Hemorrhagic Stroke

Ⅰ．緒　言

　当施設（公立豊岡病院）は兵庫県北部の急性期基幹病院であるが，出血性脳卒中の入院治療中に肺塞栓症（pulmonary embolism：PE）を発症したために転帰不良となった症例が2例続いた苦い経験から，深部静脈血栓症（deep venous thrombosis：DVT）を早期発見・早期治療介入することで，PE発症を未然に防ぐための方策に取り組んでいる．

　当施設で実施しているPE予防策において，出血性脳卒中症例におけるDVTとDダイマー値との関連性およびDVTの発症関連因子について後方視的に検討したので報告する．

　Pulmonary embolism（PE）in the early phase of stroke worsens the prognosis. It is necessary to detect deep venous thrombosis（DVT）to avoid PE. We conducted the D-dimer screening in order to detect DVT at an earlier stage. We retrospectively analyzed the clinical data of patients with hemorrhagic stroke who were admitted to the local stroke center, and investigated the complication rates of DVT, PE, D-dimer values, and risk factors of DVT. From October 2012 to August 2014, 261 patients were included. DVT was detected in 46 patients（17.6%）and anticoagulant therapy was started in 5 patients with central DVT. PE did not occur during this observation period. The D-dimer cutoff value for estimating the presence of the DVT was 8.9μg/mL, and the risk factors for DVT were older age, severe neurological disability, prolonged hospital stays, and subarachnoid hemorrhage. D-dimer screening is very useful to make earlier diagnosis and treatment of DVT.