Abstract
Introduction
Venous thromboembolism (VTE) risk following acute stroke is high. Current guidelines recommended intermittent pneumatic compression (IPC) stockings for up to 30 days in those who are immobile following acute stroke. The concern post-stroke is haemorrhagic complications when using low molecular weight heparin (LMWH). The CLOTS3 trial favoured IPC for safety in the first 30 days. However, in many cases, doses suitable for VTE prophylaxis can be used but with caution if IPC cannot be used.
Method
A spot audit of patients current VTE prophylaxis was undertaken in a stroke rehabilitation unit to look at IPC and LMWH usage. 10 patients were selected at random to look retrospectively at choice of VTE prophylaxis and how this changed during their admission.
Results
35 patients' full records were available. Five patients were within 30 days of admission. 12(34.3%) were anticoagulated, predominantly for atrial fibrillation. 15(42.8%) were on LMWH. VTE prophylaxis was not indicated in 3(8.6%) patients. 5(14.3%) were on no VTE prophylaxis. Of the 10 patients reviewed in depth 7(70%) had used IPCs for a time during their admission. IPCs were discontinued in 3 after starting anticoagulants and in 4 at the patients request. In 3 of the patients where IPCs were not tolerated there was a delay in starting an alternative form of VTE prophylaxis. Complex decisions were required in a patient started on LMWH post-neurosurgical intervention.
Conclusions
Decisions regarding VTE prophylaxis following acute stroke are complex. Changes are required frequently during inpatient admission and delays occur both on admission and when non-specialist team members are not confident in prescribing an alternative to IPCs. We would recommend a prompt to ensure VTE prophylaxis is considered on initial ward round and regular review during admission with anticipatory consideration of an alternative to IPCs by specialist clinicians if they are subsequently not tolerated.