Page 96 - ITPS-7-4

INNOSC Theranostics and
Pharmacological Sciences LMWH for VTE prophylaxis in acute stroke patients

after the initial 72 h of admission, but within 1 month stroke patients were prescribed LMWH prophylaxis based
of stay. on their stroke type (ischemic vs hemorrhagic) and stroke
In Audit 1, we found that generally, following severity (mild: Lacunar stroke [LACS]; moderate: Partial
admission to the acute stroke unit, stroke patients and staff anterior circulatory stroke [PACS]; severe: Total anterior
demonstrated a high level of compliance in using IPCDs circulatory stroke [TACS]) (Figure 1).
for VTE prophylaxis, with only 8% of patients not using 2. Study objectives
their prescribed IPCD. However, Audit 2 showed that
compliance with using IPCDs greatly reduced as patients The purpose of this work is to evaluate the incidence of
continued with their stroke recovery in the rehabilitation DVTs or PEs in patients treated with a new protocol for
unit, with 87% of patients found not to be wearing their early use of LMWH prophylaxis. The secondary objective
prescribed IPCDs despite staff recommendations. There of this study is to examine if the same patient group is
was a variety of reasons recorded in the notes, e.g., patients vulnerable to a higher incidence of symptomatic HT of
reporting pain or discomfort while using IPCDs and ischemic stroke.
patients reporting difficulty with transfers.
3. Method
Following these two auditing processes, discussions
on finding ways to improve compliance with IPCDs The data of 2351 stroke patients admitted between January
or considering alternative methods to deliver VTE 1, 2021, and July 31, 2023, were evaluated retrospectively.
prophylaxis in the stroke unit were held. After a series In our analysis, these patients were subdivided into two
of discussions at governance meetings, we introduced a groups:
new protocol in July 2022, recommending the early use • Group A consists of 1599 patients admitted between
of LMWH prophylaxis in acute stroke patients as a VTE January 1, 2021, and July 31, 2022 (19 months). The
prophylaxis strategy. This was done using enoxaparin 20 – patients in this group used IPCDs as VTE prophylaxis
40 mg (based on weight), delivered subcutaneously. Acute during the admission period for acute stroke

Patients admitted with acute stroke

Ensure online VTE form completed

Day 0 - 3 of admission:
- All new patients with reduced mobility: prescribe IPCD (if no contraindication)
- Order entry: mechanical thromboprophylaxis type: pneumatic compression
- IPCD for 30 days, or until independently mobile/discharged/declined/adverse reaction occurs
- Decision on need for LMWH thromboprophylaxis from day 3 (see below)

Hemorrhagic stroke: review from day
Ischemic stroke: review from day 3-7; 7-14; ensure BP control
ensure BP control LMWH can be prescribed:
LMWH can be prescribed:

LACS: Start day 3 From day 7-14 (depending on
BP/bleeding risk)

PACS/POCS: Start day 5

TACS: Start day 7

Figure 1. Flowchart for venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin (LMWH) therapy based on acute stroke
presentation conducted in our hospital
Abbreviations: BP: Blood pressure; IPCD: Intermittent pneumatic compression device; LACS: Lacunar stroke; PACS: Partial anterior circulatory stroke;
POCS: Posterior circulation stroke syndrome; TACS: Total anterior circulatory stroke.

Volume 7 Issue 4 (2024) 3 doi: 10.36922/itps.3250