VENOUS THROMBOEMBOLI SM
Changing clinical practice in VTE prevention
Dr. Indira Natarajan, a consultant stroke physician for the Royal Stoke University Hospital’s acute stroke team, highlights the burden of VTE on stroke aftercare and offers an insight into a pilot study evaluating the use of neuromuscular electrostimulation on the hospital’s stroke unit. In this article, he shares his experience of taking forward change to clinical practice.
A number of immobile patients who suffer ischaemic or haemorrhagic strokes are unable to tolerate intermittent pneumatic compression (IPC) to prevent venous thromboembolism (VTE). Recognising this issue, the stroke unit at Royal Stoke initiated an observational pilot study to assess a new neuromuscular electrostimulation technology to address this unmet need.
Through close collaboration with the developer of the device, Sky Medical Technology, a change to clinical practice has been pioneered to the benefit of patients and the stroke team. This work is now driving adoption of the device and change to clinical practice in other stroke centres across the UK and overseas.
The challenges of VTE VTE is a common complication for hospitalised patients, often as a result of restricted mobility. It puts patients at risk of potentially fatal blood clots, and some estimations suggest there are nearly 40,000 deaths in England per year as a result of VTE – over 62% of which could be prevented through proper management and care.1
In
particular, acute stroke patients are a highly at-risk population due to reduced mobility, with many patients left bedbound when recovering from the debilitating illness. NICE guidance (NG89) recommends intermittent pneumatic compression (IPC) as the primary early intervention method to prevent venous stasis in immobile stroke patients. However, observations from staff at the Royal Stoke University Hospital’s Stroke unit suggested that roughly 30% of our patients were unable to tolerate or were contraindicated for IPC. An alternative anti-stasis intervention was evidently needed to ensure the betterment of treatment for patients, and to ensure all patients would
AUGUST 2020
have access to a preventative measure. The Royal Stoke’s stroke unit keeps the betterment of patients at the heart of everything it does. As a team, we value remaining at the forefront of innovative treatment and care, and the importance of investing time, effort and determination into improving patient outcomes. This was the driving force behind our decision to embark upon an observational pilot study to assess a new VTE preventative method, which could prove a lifeline for at-risk immobile acute stroke patients.
Current standards of care One of the challenges facing stroke clinicians is the currently limited standard of care
for post-stroke VTE management, which in the first instance recommends the use of Intermittent Pneumatic Compression (IPC) sleeves. Not only can these prove uncomfortable for patients, there are a number of contraindications for IPC treatment; some patients present with ulcers or poor blood circulation, making IPC treatment impossible. A stroke can also impair cognitive function in patients, who may then remove the sleeves due to discomfort – making it more difficult to monitor patients to ensure they are consistently and correctly wearing the sleeves at any one time. Additionally, while anti-coagulants could be used on a small subset of patients who
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