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Device cuts DVT risk, saves stroke patients' lives

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Guidelines say go for prophylaxis

Venous thromboembolism is a common cause of hospital-related morbidity. Anticoagulants (e.g., heparin, low-molecular-weight heparin [LMWH]) reduce VTE with acceptable safety. Stroke patients have a high risk of VTE, but also a heightened bleeding risk in the setting of anticoagulants. Mechanical devices (elastic stockings, sequential compression devices) are attractive alternatives, but efficacy is unproven in many settings. Unlike previous trials that demonstrated a lack of efficacy of elastic stockings, the CLOTS 3 study provides convincing evidence that SCDs reduce VTE and decrease mortality in patients with a stroke. Although encouraging, VTE event rates remained high, 8.5%, in contrast to VTE rates of 4.8% in a prior study of enoxaparin in stroke patients.

Together, these findings support recommendations by the American College of Chest Physicians: In patients with acute ischemic stroke and restricted mobility, use prophylactic-dose subcutaneous heparin or LMWH or intermittent SCDs as opposed to no prophylaxis.

Dr. Robert Pendleton is chief medical quality officer for University of Utah Health Care, Salt Lake City, and a member of the Hospitalist News advisory board.


 

AT THE EUROPEAN STROKE CONFERENCE

"Normally these sleeves were being used for short periods in surgical patients, but we were using them for longer periods, so they brought out a softer sleeve," he observed. Anecdotally, he conceded that some people found the sleeves uncomfortable, too hot, or the system "noisy" to use.

The bottom line is that "intermittent pneumatic compression in people who are immobile with stroke reduces the risk of deep vein thrombosis," Dr. Dennis said.

He emphasized that "IPC is feasible in stroke patients, and it is relatively safe. It is an effective means of reducing venous thromboembolism after stroke, with a number needed to treat of about 28 for proximal DVT."

Intriguingly, it may also improve overall survival, "although we weren’t expecting to see that effect," Dr. Dennis said. The number needed to treat to prevent 1 death in 30 days was 43.

Dr. Dennis, Dr. Rudd, and Dr. Roffe had no relevant disclosures. The University of Edinburgh and NHS Lothian sponsored the study with funding from the Chief Scientist Office of the Scottish Government, the National Institute of Heath Research Health Technology Assessment Programme, and the Scottish Stroke Research Network. Covidien provided the equipment used in the study free of charge.

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