2016 Venous Thromboembolism

28.02.
2019 European Stroke Organisation (ESO) guidelines for prophylaxis for venous thromboembolism in immobile patients with acute ischaemic…
European Stroke Journal
European Stroke Organisation (ESO) guidelines for prophylaxis for

venous thromboembolism in immobile patients with acute ischaemic
stroke
Martin Dennis, Valeria Caso, L Jaap Kappelle, Aleksandra Pavlovic, Peter Sandercock, For the
European Stroke Organisation
First Published March 1, 2016 Research Article
https://doi.org/10.1177/2396987316628384
Abstract
Background
Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary
embolism is a frequent complication in immobile patients with acute ischemic stroke. This
guideline document presents the European Stroke Organisation guidelines for the
prophylaxis of VTE in immobile patients with acute ischaemic stroke. Guidelines for
haemorrhagic stroke have already been published.
Methods
A multidisciplinary group identified related questions and developed its recommendations
based on evidence from randomised controlled trials using the Grading of Recommendations
PDF
Assessment, Development, and Evaluation approach. This guideline document was
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reviewed within the European Stroke Organisation and externally and was approved by the
European Stroke Organisation Guidelines Committee and the European Stroke Organisation
Executive Committee.
Results
We found mainly moderate quality evidence comprising randomised controlled trials and
systematic reviews evaluating graduated compression stockings (GCS), intermittent
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pneumatic compression (IPC) and prophylactic anticoagulation with unfractionated (UFH)
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and low molecular weight heparins (LMWH) and heparinoids, but no randomised trials
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evaluating neuromuscular electrical stimulation (NES). We recommend that clinicians should
https://journals.sagepub.com/doi/abs/10.1177/2396987316628384 1/8
28.02.2019 European Stroke Organisation (ESO) guidelines for prophylaxis for venous thromboembolism in immobile patients with acute ischaemic…
use IPC in immobile patients, but that they should not use GCS. Prophylactic anticoagulation
with UFH (5000U ×2, or ×3 daily) or LMWH or heparinoid should be considered in immobile
patients with ischaemic stroke in whom the benefits of reducing the risk of VTE is high
enough to offset the increased risks of intracranial and extracranial bleeding associated with
their use. Where a judgement has been made that prophylactic anticoagulation is indicated
LMWH or heparinoid should be considered instead of UFH because of its greater reduction
in risk of DVT, the greater convenience, reduced staff costs and patient comfort associated
single vs. multiple daily injections but these advantages should be weighed against the
higher risk of extracranial bleeding, higher drug costs and risks in elderly patients with poor
renal function associated with LMWH and heparinoids.
Conclusions
IPC, UFH or LMWH and heparinoids can reduce the risk of VTE in immobile patients with
acute ischaemic stroke but further research is required to test whether NES is effective. The
strongest evidence is for IPC. Better methods are needed to help stratify patients in the first
few weeks after stroke onset, by their risk of VTE and their risk of bleeding on
anticoagulants.
Keywords
Stroke, deep vein thrombosis, pulmonary embolism, guidelines
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28.02.

European Stroke Journal

European Stroke Organisation (ESO) guidelines for prophylaxis for

Google Scholar | Crossref | Medline | ISI |

2006; 253: 135.

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