Deep Vein Thrombosis Prevention in Acute Ischemic Stroke Patients with Lower Limb Paralysis: A Narrative Review

Patients with lower limb paralysis following acute ischemic stroke (AIS) are at a markedly increased risk of deep vein thrombosis (DVT), which may lead to pulmonary embolism and substantially higher mortality and disability. This review comprehensively reviews studies from the past decade on the epidemiology, pathophysiology, and prevention of DVT in AIS patients with lower limb paralysis. The pathogenesis of DVT in this population is multifactorial, involving venous stasis due to immobility, stroke-induced hypercoagulability, endothelial dysfunction, neutrophil extracellular trap-mediated immunothrombosis, and autonomic dysregulation. Effective prevention requires individualized risk stratification, integrating clinical assessment, biomarkers, and imaging tools. Current prophylactic strategies include pharmacological anticoagulation (primarily low-molecular-weight heparin), mechanical interventions (such as intermittent pneumatic compression), and early mobilization and rehabilitation. While combined approaches have demonstrated significant benefits, challenges remain regarding the timing of anticoagulation, balancing bleeding risks, extended thromboprophylaxis, and novel immunothrombosis targets. Future research should focus on personalized prevention protocols, the application of artificial intelligence-based predictive models, and innovative therapies targeting endothelial injury and immune-mediated thrombosis, aiming to improve thromboprophylaxis and overall outcomes in this high-risk population.