Venous thromboembolism after acute stroke has long been a diagnostic and management problem. From the realisation in the 1970s that the incidence of deep-vein thrombosis could be as great as 75 % because of a high unrecognised subclinical element, and silent pulmonary embolism may be the cause of a high proportion of post-stroke deaths, the concern has been on how to prevent this potentially deadly complication. The use of subcutaneous low-dose anticoagulation successful in other groups of high-risk patients has been fraught with the fear of causing intracranial haemorrhage in ischaemic stroke and extending bleeding in intracranial haemorrhage. Some have felt that the benefi ts of anticoagulation outweigh the risk, especially when using low-molecular-weight heparin, others have opted for mechanical prophylaxis which until recently had scant evidence in acute stroke. Meanwhile, improvements in acute stroke care appears, in itself, to have led to a fall in the incidence of venous thromboembolism, making the case for benefi t over risk of prophylactic anticoagulation less clear. Recent large trials have also both clarifi ed and strengthened the case for mechanical thromboprophylaxis, showing clearly that graduated compression stockings were not benefi cial, but intermittent pneumatic compression did prevent deep-vein thrombosis and reduce mortality. Venous thromboembolism when it occurs should be treated as a matter of urgency with anticoagulation or an inferior vena cava fi lter if the risk of bleeding is high.
Keywords
Key Messages• Occurs early after stroke and presents a diagnostic and management challenge.• Risk factors include severity of the stroke, immobility, and dehydration.
