Blood Clots

Midwest Stroke Action Alliance Presentation Features Stroke VTE Safety Recommendations and Blood Clot Prevention

The Midwest Stroke Action Alliance recently hosted a panel of health experts on the risks of venous thromboembolism (VTE which is commonly referred to as blood clots).

The health experts on the panel were:

    • Mark J. Alberts, MD (Clinical Vice-Chair for Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center)
    • Laurie Paletz, BSN, PHN, RN-BC (Stroke Program Coordinator, Cedars-Sinai Medical Center)
    • Michael W. Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)

Stroke is a leading cause of death and disability in the U.S., with 800,000 cases occurring each year. Each year in the United States, an estimated 300,000 cases of VTE occur. Mortality can be as high as 3.8 percent in patients with deep vein thrombosis (DVT) and 38.9 percent in those with pulmonary embolism (PE). VTE is associated with a high risk of death in the U.S. and Europe, with an estimated incidence rate of 1 in 1,000 patients. VTE is particularly common after a stroke. Approximately 20 percent of hospitalized immobile stroke patients will develop DVT, and 10 percent a PE.

Dr. Alberts spoke about the results of the recent CLOTS 3 study which showed a 29 percent reduction in life-threatening DVT — and a 14 percent reduction in overall mortality — for patients receiving intermittent pneumatic compression (IPC) therapy. The CLOTS 3 Study looked at the effectiveness of IPC in reduction of risk of DVT in patients who have had a stroke.

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Dr. Alberts said there are five key benefits to using thigh-length IPC, as studied in CLOTS 3:

  1. Non-invasive approach
  2. Generally well tolerated
  3. Minimal side effects
  4. Less costly than medications
  5. Can be used in all types of stroke patients

In discussing the need to assess and treat stroke patients in as short a period of time as possible, Ms. Paletz said that successful health outcomes in stroke patients often depends on having as short a door-to-treatment time as possible. Delays in evaluation and initiation of therapy should be avoided because the opportunity for improvement is greater with earlier treatment. This not only means having a collaborative team effort, but looking at anything that might shorten door-to-treatment times, including having designated parking for stroke patients.

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The provision of needed prophylaxis has been sub-optimal. Ms. Paletz encouraged clinicians to use available VTE treatments and order IPC treatment for their stroke patients. Clinicians should make sure that IPC is being used and not just hanging across the bedrail, and that the patient is not only wearing IPC, but that it is turned on.

Mr. Wong discussed the Stroke VTE Safety Recommendations. These Recommendations may help reduce death and disability among stroke victims due to VTE. Developed by a group of leading neurological health and patient safety experts brought together by the Physician-Patient Alliance for Health & Safety, the Stroke VTE Safety Recommendations incorporate the latest research.

The Stroke VTE Safety Recommendations provide four concise steps that:

  1. Assess all admitted patients with a stroke or rule out stroke diagnosis for VTE risk with an easy to use checklist.
  2. Provide the recommended prophylaxis regimen, which includes the use of mechanical prophylaxis and anticoagulant therapy.
  3. Reassess the patient every 24 hours, prior to any surgical or procedural intervention or change in the patient’s condition.
  4. Ensure that the patient is provided appropriate VTE instructions and information upon hospital discharge or transition to rehabilitation.

A pdf of the Stroke VTE Safety Recommendations can be viewed by clicking here.

For a pdf of the presentation, please go to http://bit.ly/1gGmGSA

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