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

therapy sessions, and patients reporting difficulty with the early use of LMWH prophylaxis in acute stroke
transfers or positioning in bed. These situations were patients as a VTE prophylaxis strategy. This was done
discussed in the local stroke governance meetings, and using enoxaparin 20 – 40 mg (based on weight), delivered
measures were taken to improve VTE compliance, e.g., subcutaneously. Acute stroke patients were prescribed
staff checking IPCD compliance during each nursing and LMWH prophylaxis based on their stroke type (ischemic
medical ward round. At our institute, we followed the UK and hemorrhagic) and stroke severity (mild: LACS from
Stroke Guidelines 2016 (now replaced by the 2023 version, day 3; moderate: PACS from day 5; severe: TACS from
with the same document title). Accordingly, “patients with day 7) (Figure 2). Following this new protocol for VTE
immobility after acute stroke should be offered IPC within prophylaxis, we noted an improvement in VTE compliance
3 days of admission to hospital for the prevention of DVT. among patients admitted to the stroke ward, probably due
Treatment should be continuous for 30 days or until the to regular monitoring done on the patients receiving VTEs
patient is mobile or discharged, whichever is sooner.” 33.p.60 prophylaxis and the LMWH being better tolerated by the
However, despite staff checking, compliance was still found patients. Furthermore, the incidence of DVT in stroke
to be lacking with IPCD use. patients reduced, as no cases have been identified since the
Following discussions at governance meetings, we implementation of the new protocol. Both Groups A and B
introduced a new protocol in July 2022, recommending have more cases of asymptomatic incidental PE compared
with DVTs. Relatively, the incidence of PE was slightly
increased in Group B as compared to Group A, after taking
into consideration their cohort size (Figure 3). This is
probably due to the lower number of patients in Group B
being analyzed (752 vs 1599 patients), which is a pitfall of
this analysis. However, there was only a small proportion
of patients with post-stroke PE in Group B who became
symptomatic with shortness of breath or reduced blood
oxygen saturation levels (Figure 4). Interestingly, one of
the cases, who was admitted with a posterior circulatory
stroke (POCS), showed no reduced mobility even if IPCD
was prescribed. The patient later, on day 4 of admission,
developed symptomatic PE.
In this study, we observed that being male with age
around 71 – 80 years and/or having health issues such as
Figure 4. Incidence of stroke-related pulmonary embolism diabetes mellitus, hypertension, and cardiac problems are

Table 2. Demographics of the patients from Groups A and B with pulmonary embolism and deep vein thrombosis
Group A (n=14) Group B (n=6) N (number) Percentage
Gender
Male 8 5 13 65
Female 6 1 7 35
Age group
51 – 60 years 2 1 3 15
61 – 70 years 3 2 5 25
71 – 80 years 5 2 7 35
81 – 90 years 4 1 5 25
Thromboembolism risk factors
Hypertension 5 3 8 40
Diabetes mellitus 5 2 7 35
Ischemic heart disease or heart failure 3 1 4 20
Chronic illness or malignancy 5 1 6 30

Volume 7 Issue 4 (2024) 5 doi: 10.36922/itps.3250