# Stroke severity and other predictors of venous thromboembolism in stroke patients—a population-based cohort study

## TL;DR

This study identifies stroke severity, active cancer, and prior VTE as strong predictors of post-stroke venous thromboembolism, helping identify high-risk patients.

## Contribution

The study provides new evidence that stroke severity is a consistent predictor of post-stroke VTE across both acute and subacute phases.

## Key findings

- Severe stroke, active cancer, and previous VTE were strong predictors of post-stroke VTE.
- The risk of VTE was 2- to 5-fold higher in patients with these risk factors.
- Findings were consistent for both ischemic stroke and intracerebral hemorrhage.

## Abstract

Venous thromboembolism (VTE) frequently occurs after stroke, particularly within the first 3 months after diagnosis. Poststroke VTE is associated with increased mortality. Stroke severity is a known predictor of adverse prognosis; however, its ability to predict VTE is unclear. Knowledge regarding other predictors of poststroke VTE is lacking.

To identify clinical predictors of poststroke VTE in the subacute and acute phases, and to assess the association between stroke severity and poststroke VTE.

In a population-based cohort study, we identified patients (aged ≥18 years and without recent VTE) with first-time ischemic stroke (N = 129,345) or intracerebral hemorrhage (N = 16,887) from 2004-2021. We computed the cumulative incidence proportion and subdistribution hazard ratio for VTE for each potential predictor in the subacute phase (3 months) and acute phase (7 days). For stroke severity, measured with the Scandinavian Stroke Scale, we calculated adjusted subdistribution hazard ratios in 2 multivariable models including (1) age and sex, and (2) predictors identified in the univariable analyses.

In the subacute phase, 1016 (0.8%) patients developed VTE after ischemic stroke, and 200 (1.2%) patients developed VTE after intracerebral hemorrhage. In univariable analyses, VTE risk was 2- to 5-fold higher in those with severe stroke, active cancer, and previous VTE. These findings were consistent for both stroke subtypes and follow-up periods. Multivariable analyses showed no substantial alterations in the estimates for stroke severity.

Stroke severity, active cancer, and previous VTE strongly predict poststroke VTE in patients in the subacute and acute phases. These findings offer valuable insights and can be used to identify patients at elevated risk of VTE in whom extended thromboprophylaxis may be considered.

•Venous thromboembolism occurs after stroke and increases mortality, but predictors remain unclear.•Cohort study of first-time stroke patients assessed predictors of venous thromboembolism.•Severe stroke, active cancer, and prior venous thromboembolism predict poststroke venous thromboembolism.•Findings highlight patients at higher risk who may benefit from extended thromboprophylaxis.

Venous thromboembolism occurs after stroke and increases mortality, but predictors remain unclear.

Cohort study of first-time stroke patients assessed predictors of venous thromboembolism.

Severe stroke, active cancer, and prior venous thromboembolism predict poststroke venous thromboembolism.

Findings highlight patients at higher risk who may benefit from extended thromboprophylaxis.