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VTE Prevention - Acute Stroke

Reducing VTE risk
in acute stroke patients

Current practice acknowledges that a reduction in venous stasis of the lower limb reduces DVT incidence in acute stroke patients1.  It is also recognised that DVT is a blood clot that most commonly forms in the deep veins of the calf2.

A study performed by Labropoulos et al demonstrates that isolated calf DVT was detected in 282 limbs of 251 patients examined. The peroneal veins were most frequently involved with 115 limbs affected (41%).  Posterior tibial and gastrocnemius vein involvement accounted for 37% and 29% respectively2.

Publication of a study by Professor Andrew Nicoladies and Dr Maura Griffin measured the effect of the geko™ device on blood flow in the deep veins of the calf. The study shows statistical significance (P<0.001-0.05), with significant volume and velocity increases in the gastrocnemius, peroneal and posterior tibial veins. This is the first time that a mechanical device has been able to demonstrate enhancement to blood flow for the prevention of stasis in the deep veins of the calf. The findings are of clinical relevance to the unmet need of DVT prophylaxis.

Current practice is also based on the CLOTS-3* study, which reports that only around 31% of stroke patients had perfect adherence to intermittent pneumatic compression (IPC). In addition to contraindications to IPC, patients also become intolerant to IPC. These patients, who received only standard of care treatment without a mechanical intervention, carried a 6.3% risk of developing a symptomatic DVT4. This suggests a significant level of unmet need and associated clinical burden.

Through a prospective audit of clinical practice, Firstkind partnered with a major NHS Trust to assess use of the geko™ device for VTE prophylaxis in the acute stroke pathway.

The results show that the geko™TM is as effective as IPC at reducing DVT. The geko™ was well tolerated and offered an alternative prophylaxis strategy to IPC, ensuring all patients received VTE prophylaxis, where previously no prophylaxis could be given5

Interim results show

  • 126 patients did not require a VTE prophylaxis strategy.
  • 445 patients received a VTE intervention
  • 6/445 patients (1.3%) developed symptomatic VTE (3 DVTs and PEs) within 90 days
  • Of these, 4 patients (1.6%) were prescribed IPC, 1 patient (1.3%) was prescribed IPC then the geko™ device, as a secondary intervention, and 1 patient (1.5%) patient was prescribed anticoagulation.
  • There was no DVT or PE in patients treated with the geko™ device as the primary VTE prophylaxis.
  • Of the 390 patients who received a form of mechanical intervention 139 required the geko™ device.
  • Worn on both legs for 24 hours a day, the average length of geko™ wear is 5 days.

The geko™ device is cost saving

NICE guidance (MTG19) recommends use of the geko™ device when other prophylactic methods can be used and estimates a cost saving of £197 per patient when the device is used for a period of 6 days6.

*The CLOTS-3 paper provided the evidence underlying the NICE guideline recommendation for IPC as first line VTE prophylaxis

References

  1. CLOTS3 health technology assessment 2015 volume 19 issue 79
  2. Labroupoulos N, Webb M, Kang SS, Mansour A, Filliung DR, Size GP, et al. Patterns and distribution of isolated calf deep vein thrombosis. J Vasc Surg 1999;30:787-91.
  3. A.Nicolaides, M Griffin, Measurement of blood flow in the deep veins of the lower limb using the geko™ neuromuscular electro-stimulation device. Journal of International Angiology August 2016-04.
  4. M. Dennis; P. Sandercock; J. Reid; C. Graham; J. Forbes; G. Murray. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet. 2013; 382(9891):516-24.
  5. J. Williams1, C. Roffe1, Natarajan1, C. Moss1, C. Lambert1, L. Richards2. The use of the geko™ device and the activation of the foot and calf pumps for prevention of venous thromboembolism in patients with acute stroke. 1. University Hospital of North Midland NHS Trust, Acute Stroke Unit, Stoke on Trent, United Kingdom. 2. Undergraduate School of Medicine- Keele University, Stoke on Trent, United Kingdom.
  6. NICE Guidelines (MTG19). Published date June 2014.

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