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New Stroke VTE Safety Recommendations

Guidelines aim to reduce death and disability

The Physician–Patient Alliance for Health & Safety (PPAHS) has released safety recommendations targeting the prevention of venous thromboembolism (VTE) in stroke patients.

Stroke is a leading cause of death and disability in the U.S., with 800,000 cases occurring each year.

Evidence shows that “the health of approximately one in three stroke patients will deteriorate within 24 hours after suffering a stroke. This points to a critical need for intensive continuous monitoring of blood pressure, temperature, oxygenation, and blood glucose of all stroke patients to rapidly assess and protect their health and safety,” explains Deborah V. Summers, Stroke Program Coordinator at Saint Luke’s Health System’s Marion Bloch Neuroscience Institute. “One of the deteriorating conditions that may develop with 24 hours of a stroke incident and which may be preventable is PE [pulmonary embolism], which may be fatal. If VTE [venous thromboembolism] risk factor and prophylactic measures are instituted early on, fatal PE may be prevented.”

VTE is a common and potentially avoidable cause of death and illness in hospitalized patients. With approximately 300,000 total cases per year, VTE is particularly common in stroke patients. Approximately 20% of hospitalized, immobile stroke patients will develop deep vein thrombosis (DVT), and 10% will develop a PE. Mortality can be as high as 3.8% in patients with DVT and 38.9% in those with a PE.

Despite these statistics, the use of VTE prophylactic treatment has been shown to be suboptimal for admitted patients in general, according to the PPAHS.

“Based on the high incidence of DVT and PE in patients with stroke, prophylaxis of VTE is recommended for all patients with stroke admitted to the hospital with weakness,” said Mark Reiter, MD, MBA, of the University of Tennessee at Murfreesboro.

Reiter recommends the use of intermittent pneumatic compression and cites the landmark Clots 3 study. “We have the clinical evidence –– let’s use it,” he says. “Martin Dennis, MD, led a study of nearly 3,000 stroke patients in the United Kingdom comparing the efficacy and safety of intermittent pneumatic compression (IPC) therapy against routine care (hydration, aspirin, graduated compression stockings, and/or anticoagulants). The study’s purpose was to evaluate the effectiveness of IPC in decreasing the risk of proximal DVT in patients who have had a stroke. Sponsored by the University of Edinburgh and the National Health Service, the randomized study found a 29% reduction in life-threatening DVT — and a 14% reduction in overall mortality — for patients receiving IPC therapy. Clots 3 is a landmark study that should transform the clinical practice to prevent DVT in stroke patients.”

The Stroke VTE Safety Recommendations are aimed at reducing death and disability among stroke victims due to VTE. They provide four concise steps that allow clinicians to:

  1. Assess all admitted patients with a stroke or rule out a stroke diagnosis for VTE risk with an easy-to-use checklist.
  2. Provide the recommended prophylaxis regimen, which includes the use of mechanical prophylaxis and anticoagulant therapy.
  3. Reassess the patient every 24 hours before a surgical or procedural intervention or a change in the patient’s condition.
  4. Ensure that the patient is provided appropriate VTE instructions and information after hospital discharge or transition to rehabilitation.

Sources: PPAHS; February 11, 2015; and Stroke VTE Safety Recommendations; February 2015.

 

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