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VTE Prevention

Royal Stoke University Hospital, UHNM NHS Trust

Reducing VTE risk in acute stroke patients

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Following the positive results of our clinical audit within our acute stroke unit, the geko™ device is now in routine use and has marked a significant change to our nursing practice. The audit has shown a need to use the geko™ when other VTE prophylaxis strategies are contraindicated or impractical. This pathway enhancement ensures that all acute stroke patients now have another VTE prophylactic intervention option where previously patients would have had no other intervention available to them.

In a prospective audit of clinical practice, we partnered with Firstkind to assess use of the geko™ device for VTE prophylaxis in the acute stroke pathway, with the aim of measuring patient and staff acceptability and geko™ impact on VTE (venous thromboembolism).

Interim real world data collected from 581 patients has shown that of patients requiring a mechanical intervention, 36%1 of stroke patients in the audit were contraindicated or became intolerant to IPC. It is to this unmet need patient group that we fitted and evaluated use of the geko™ device.

The addition of the geko™ device as a mechanical prophylaxis option has resulted in a very low VTE rate, with no VTE reported in the group treated with the geko™ device. The geko™ is well tolerated and offers an alternative prophylaxis strategy to IPC, ensuring all patients now have VTE prophylaxis1.

Interim results show1:

  • 126 patients did not require a VTE prophylaxis strategy.
  • 455 patients received a VTE intervention
  • 6/455 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.

 

Clinical practice

Change to clinical practice has been a significant outcome of the audit. The audit increased our surveillance of IPC compliance. We now have immediate insight of high-risk patients who cannot be prescribed or become intolerant to IPC, and immediate and targeted use of the geko™ device to ensure continuous anti-stasis therapy for all high-risk stroke patients.

The geko™ device is cost saving

NICE guidance (MTG19) recommends use of the geko™ device when other prophylactic methods cannot be used and estimates a cost saving of £197 per patient when the device is used for a period of 6 days2.

The CLOTS-3 paper3 provided the evidence underlying the NICE guideline recommendation for IPC as first line VTE prophylaxis.

 

Benefits

Zero

No DVT or PE reported in patients treated with the geko™ device, as the primary VTE prophylaxis.

36%

Real world data shows up to 36% of acute stroke patients who were prescribed a mechanical intervention needed geko™ VTE prophylaxis.

£197

NICE guidance estimates a cost saving of £197 per patient.

References

  1. J. Williams1, C. Roffe1, I. 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.
  2. NICE Guidelines (MTG19). Published date June 2014.
  3. 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.

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