New Stroke VTE Safety Recommendations Prevent Blood Clots In Stroke Patients

Health Expert Panel Encourage Use of Venous Thromboembolism Recommendations to Reduce Adverse Events and Save Lives

The Physician-Patient Alliance for Health & Safety is pleased to announce the release of 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, Saint Luke’s Health System’s Marion Bloch Neuroscience Institute). “One of the deteriorating conditions that may develop within 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 about 300,000 total cases per year, VTE is particularly common in stroke patients. Approximately 20 percent of hospitalized immobile stroke patients will develop a deep vein thrombosis (DVT), and 10 percent a pulmonary embolism (PE).

Mortality can be as high as 3.8 percent in patients with DVT and 38.9 percent in those with PE.

Despite these statistics, the use of VTE prophylactic treatment has been shown to be suboptimal for admitted patients in general.[1] When specifically looking at stroke patients, it has been found to be “underutilized and rarely started after the first day of hospitalization.

”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”, says Mark Reiter, MD, MBA (CEO, Emergency Excellence Residency Director, The University of Tennessee at Murfreesboro; President, American Academy of Emergency Medicine).

Dr. Reiter recommends the use of intermittent pneumatic compression and cites the landmark Clots 3 study. “We have the clinical evidence – let’s use it,” says Dr. Reiter. “Martin Dennis, MD (University of Edinburgh, Western General Hospital) 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-percent reduction in life-threatening DVT — and a 14 percent 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 may help reduce death and disability among stroke victims due to VTE. Developed by a group of leading neurological health and patient safety experts brought together by the Physician-Patient Alliance for Health & Safety, the Stroke VTE Safety Recommendations incorporate the latest research.

The Stroke VTE Safety Recommendations provide four concise steps that:

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

A pdf of the Stroke VTE Safety Recommendations can be viewed by clicking here.

[1] Gaspar L, Stvrtina S, Ocadlik I et al. Autopsy-proven pulmonary embolism: a major cause of death in hospitalized patients. Adv Orthop. 2010;2:8-14.

Caprini JA, Tapson VF, Hyers TM, et al; for the NABOR Steering Committee. Treatment of venous thromboembolism: adherence to guidelines and impact of physician knowledge, attitudes, and beliefs. J Vasc Surg. 2005;42:726-733.

Yu HT, Dylan ML, Lin J, Dubois RW. Hospitals’ compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm. 2007;64:69-76.

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