Management of Calf Muscle Venous Thrombosis after Stroke: A Systematic Review and Meta-Analysis

Background and PurposeCalf muscle venous thrombosis (MVT) is a common complication after stroke. However, the optimal management strategy remains controversial. This systematic review aimed to: (1) evaluate the efficacy and safety of early mobilization versus immobilization for MVT prevention and treatment after stroke; (2) compare the effectiveness of different mechanical prophylaxis methods; and (3) analyze the differences in MVT risk and management strategies between patients with intracerebral hemorrhage (ICH) and ischemic stroke (IS). MethodsPubMed, EMBASE, Cochrane Library, Web of Science, and CNKI databases were searched for randomized controlled trials (RCTs) comparing early mobilization versus immobilization, different mechanical prophylaxis methods, and observational studies comparing MVT risk between different stroke types. The Cochrane Risk of Bias tool and Newcastle-Ottawa Scale were used to assess study quality. Meta-analysis was performed using RevMan 5.4. ResultsA total of 8,542 articles were retrieved, and 68 studies were finally included, consisting of 15 randomized controlled trials, 32 cohort studies, 15 case-control studies, and 6 systematic reviews/guidelines. Meta-analysis showed that early mobilization significantly reduced DVT incidence (RR=0.61, 95%CI: 0.48-0.78, P<0.001) without increasing PE risk (RR=0.93, 95%CI: 0.51-1.70, P=0.82). Intermittent pneumatic compression (IPC) was the most effective mechanical prophylaxis method (RR=0.55, 95%CI: 0.42-0.72, P<0.001), while graduated compression stockings (GCS) were ineffective (RR=0.94, 95%CI: 0.74-1.20, P=0.65). Importantly, ICH patients had a significantly higher MVT incidence (5.8%) compared with IS patients (2.1%), with an odds ratio of 7.42 (95%CI: 5.21-10.56, P<0.001). ConclusionsEarly mobilization is safe and effective for preventing DVT after stroke. IPC is recommended as the first-line mechanical prophylaxis, while GCS should not be used alone. ICH patients have a 7.42-fold higher risk of developing MVT compared with IS patients, highlighting the need for more aggressive prevention strategies in this high-risk population.