Table 1. Studies on Deep Vein Thrombosis in Acute Stroke.

CDU: compression duplex ultrasound; CRP: C-reactive protein; DVT: deep venous thrombosis; ECH: extracranial hemorrhage; ECS: elastic compression stockings; GCS: graduated compression stockings; GWTG-Stroke: Get With The Guidelines–Stroke; ICH: intracranial hemorrhage; IPC: intermittent pneumatic compression; IU: international units; IVCF: inferior vena cava filters; LMWH: low molecular weight heparin; N/A: not available; PE: pulmonary embolism; RCTs: randomized controlled trials; SC: subcutaneous; SCDs: sequential compression devices; SICH: symptomatic intracranial hemorrhage; UFH: unfractionated heparin; VTE: venous thromboembolism

Study author(s)	Type of study	# of patients	Treatments studied	Primary efficacy endpoints and results	Safety endpoints	Comments
Bembenek J, et al. 2011 [1]	Cohort prospective study	299	LMWH as given to the patients with the high risk of DVT.	N/A	N/A	Additional care to patients with increased serum CRP levels.
Soroceanu A, et al. 2016 [2]	Retrospective review	448	Patients undergoing spinal surgery.	Medical complications including stroke, DVT, and PE, were studied.	N/A	N/A
Kamran SI, et al. 1998 [3]	Clinical trial	233 Grp A, 432 Grp B, 16 Grp C	Pneumatic SCDs, subcutaneous heparin, and anti-embolic hose	N/A	N/A	Adding SCDs to treatment with subcutaneous heparin and anti-embolic hose reduced the risk of DVT and PE.
Kelly J, et al. 2001 [7]	Review Article	N/A	IVCF, Anticoagulants	N/A	N/A	Early use of short-term, low-dose, UFH is not associated with sustained, clinically meaningful benefit
Dennis M, et al. 2011 [15]   CLOTS (Clots in Legs Or sTockings after Stroke) Trial Collaboration	Randomized trial	(3,114 Total) 1,552 with thigh-length stockings 1,562 with below-knee stockings	Thigh length vs. below knee stockings	Proximal DVT, alive and free of the primary outcome, or died before any primary outcome.	Dead by 30 days; symptomatic or asymptomatic proximal DVT; any symptomatic or asymptomatic DVT affecting the calf, popliteal, or femoral veins; or pulmonary emboli within 30 days.	Unfortunately, models based on clinical factors alone discriminate poorly between immobile patients with stroke at high and low risk, and would not facilitate individual tailoring of DVT prophylaxis strategies.
Kamerkar DR, et al. 2016 [16]	Retrospective review	549	Confirmed diagnosis of VTE. DVT confirmed by Doppler ultrasonography.	N/A	N/A	Bleeding was not the limiting factor for anticoagulant treatment in most patients.
Paciaroni M, et al. 2011 [18]	Review article	1,000 (4 studies)	Comparing anticoagulants with other treatments like elastic stockings and IPC.	Symptomatic and asymptomatic DVT, symptomatic and asymptomatic pulmonary embolisms, and death at the final time of follow-up (varying between seven days and three months)	Symptomatic and asymptomatic hematoma enlargement	Early anticoagulation is associated with a significant reduction in PE, no substantial reduction in death, and a non-significant increase in hematoma enlargement.
Bath PM, et al. 2000 [19]	Systemic review of RCTs	3,048 (11 completed RCTs)	LMWH	N/A	N/A	LMWHs do reduce the risk of DVT and PE but only at the expense of an increased risk of major extracranial hemorrhage and probably SICH.
Kamphuisen PW, et al. 2005 [21]	Review article	(Multiple studies)	Mechanical methods, anticoagulants.	N/A	N/A	Higher doses increase the risk of cerebral bleeding and should be avoided for prophylactic use. Both aspirin and mechanical prophylaxis are suboptimal to prevent VTE. GCS should be reserved for patients with a clear contraindication to antithrombotic agents.
Kamphuisen PW, et al. 2005 [22]	Review article	23,043 (16 trials)	DVT prophylaxis	N/A	N/A	Low-dose LMWH had the best benefit/risk ratio in patients with acute ischemic stroke by decreasing the risk of both DVT and pulmonary embolism, without a clear increase in ICH or ECH.
Dumas R, et al. 1994 [24]	Clinical trial	179	Org 10172 (1250 anti-Xa units SC once daily); heparin sodium (5,000 IU SC twice daily)	N/A	N/A	1,250 anti-Xa units of Org 10172 once daily was both safe and as effective as 5,000 IU of heparin sodium twice daily for DVT prophylaxis in patients with acute ischemic stroke of recent onset.
Naccarato M, et al. 2010 [28]	Review Article	2,615 (2 RCTs of GCS); 177 (2 studies of IPC)	GCS, IPC, ECS	Events during scheduled treatment period: 1) Deaths from any cause; 2) DVT; 3) Fatal or non-fatal PE. Adverse effects	Events during scheduled follow-up period: 1) Deaths from any cause; 2) DVT; 3) Fatal or non-fatal PE.	Did not support the routine use of GCS. Insufficient evidence to support IPC.
Xu B, et al. 2010 [29]	Review article	Muir: 65; CLOTS1: 2,518; Cochrane: 123	GCS	N/A	N/A	GCS increased the risk of skin problems in this population. They may also increase the risk of critical limb ischemia and are contraindicated in patients with the known peripheral vascular disease or an ankle-brachial index <0.8.
Dennis M, et al. 2013 [30]   CLOTS (Clots in Legs Or sTockings after Stroke) Trial Collaboration	Randomized trial	5,632	Efficacy and safety of GCS	The occurrence of asymptomatic or an asymptomatic DVT in the popliteal or femoral veins detected by CDU or asymptomatic DVT in the popliteal or femoral veins, which had been confirmed on imaging, within 30 days of randomization.	Secondary outcomes relevant to this analysis include death, and `any DVT’ (including the calf, popliteal or femoral) and `symptomatic DVT` within 30 days.	Models based on clinical factors alone discriminate poorly between immobile patients with stroke at high and low risk.
Hara Y, et al. 2008 [31]	Original study	272	Antiplatelet (Cilostazol) and anticoagulants	N/A	N/A	Cilostazol seemed effective in protecting again venous endothelial damage following DVT.
Chua K, et al. 2008 [32]	Prospective observational single-center	419	Mechanical prevention. Anticoagulants (in selected population).	N/A	N/A	Asymptomatic lower limb DVT is indeed uncommon in Asian neurorehabilitation admissions.
Orken DN, et al. 2009 [34]	Prospective randomized study	75	LMWH and GCS	Development of symptomatic or asymptomatic DVT or PE.	Enlargement of hemorrhage. The occurrence of new hemorrhage.	Low-dose heparin treatment after 48 hours of stroke in ICH patients is not associated with an increased hematoma growth and should be used for DVT and PE prophylaxis.
Zubkov AY, et al. 2009 [35]	Review article	(Multiple RCTs)	Mechanical prevention, anticoagulants	N/A	N/A	Mechanical devices, such as IPCs, significantly decrease the occurrence of asymptomatic DVT for patients with ICH as compared with elastic stockings alone, although this advantage was not found in a meta-analysis of prospective studies
Tetri S, et al. 2008 [36]	Retrospective study	407	Enoxaparin (LMWH)	N/A	Hematoma enlargement	No increased mortality among ICH patients who survived the first two days after the onset of ICH and were afterward treated with enoxaparin.
Bravata DM, et al. 2010 [39]	Retrospective cohort study	1,487	Deep vein thrombosis (DVT) prophylaxis, and early mobilization.	Combined endpoint of hospital mortality, discharge to hospice, or discharge to a skilled nursing facility.	N/A	Patients with stroke who received a DVT prophylaxis were less likely to have poor outcomes.
Smith EE, et al. 2009 [40]	Registry	479, 284 (Consecutive stroke and TIA admissions.)	Acceptable treatments: Pneumatic compression devices and anticoagulants	N/A	N/A	GWTG-Stroke database participation was associated with improving quality of care for hemorrhagic stroke
Dennis M, et al. 2015 [41] CLOTS (Clots in Legs Or sTockings after Stroke) Trial Collaboration	Randomized trial	2,876	Thigh-length sleeves to both legs	The occurrence of a symptomatic or asymptomatic proximal DVT confirmed on CDU within 30 days of randomization.	Survival to six months; disability; and hospital costs (based on the cost of IPC and length of hospital stay).	IPC appeared to reduce the risk of DVT and probably improved survival in all immobile stroke patients. IPC should be considered in all immobile stroke patients, but that the final decision should be based on individual’s prognosis.
Hadziahmetovic NV, et al. 2009 [42]	Original study	86	Aspirin, Physical therapy.	N/A	N/A	For patients with acute stroke and limited mobility, it was recommended to use heparin or LMWH in preventive doses if there are no contraindications for anticoagulants, with physical therapy and mechanical methods of prophylaxis.
Zheng H, et al. 2008 [43]	Multicenter prospective cohort study	656	Antiplatelets, anticoagulants, IPC, and stockings	N/A	N/A	Guidelines for preventing DVT in acute stroke should be established, and efforts should be made to improve venous thromboembolism prophylaxis practice
Tan SS, et al. 2007 [44]	Case reports	44	N/A	N/A	N/A	The institution of early DVT screening with Doppler ultrasound for stroke patients was not recommended.
Rabadi MH, et al. 2009 [45]	Review article	(35 RCTs)	Compression stockings, IPC	N/A	N/A	Exercise programs for community-dwelling stroke patient helped maintain and even improve their functional state.
Hills NK, et al. 2006 [46]	Cohort registry	16,301	DVT prophylaxis	N/A	N/A	Three targeted quality-improvement measures improved among hospitals participating in a disease-specific registry.
Zorowitz RD, et al. 2005 [47]	Cohort registry	1161	Warfarin, heparin, enoxaparin, dalteparin, and alteplase	N/A	N/A	Unless patients have any medical contraindications to these medications, they should receive these evidence-based treatments for secondary stroke prophylaxis.
Roderick P, et al. 2005 [48]	Review article	(Multiple RCTs)	Mechanical methods, oral anticoagulation, dextran, and regional anesthesia as thromboprophylaxis.	DVT, PE, and major bleeding events	Proximal venous thrombosis (PVT) and fatal PE	There was little information on the prevention of VTE among high-risk medical patients (such as those with stroke), so further randomized trials in this area would be helpful.
Wilson RD, et al. 2005 [49]	Prospective study	N/A	(Cost-effectiveness analysis)	N/A	N/A	This study estimates that the cost-effectiveness ratio was considerably higher than that reported in other rehabilitation conditions.
Jaff MR, et al. 2005 [50]	Multicenter prospective cohort study	5,451	IVCF placement	N/A	N/A	Improved physician education regarding mechanical and pharmacologic prophylaxis alternatives might reduce the use of IVCFs.