Venous Thromboembolism After Acute Stroke

Abstract

Background-Treatment for venous thromboembolism (VTE) is highly effective in preventing morbidity and mortality, yet pulmonary embolism (PE) accounts for up to 25% of early deaths after stroke. This is because the current diagnostic paradigm is reactive rather than proactive: the clinician responds to VTE when it becomes symptomatic, in the expectation that initiation of treatment will prevent progression to more serious manifestations. This approach is flawed, because sudden death from PE is frequently unheralded and nonfatal symptomatic pulmonary emboli are often unrecognized or misdiagnosed. Summary of Comment-Morbidity and mortality from PE could be reduced either by more effective thromboprophylaxis or earlier diagnosis and treatment of established VTE. The fact that early use of short-term, low-dose, unfractionated heparin (UFH) is not associated with sustained, clinically meaningful benefit suggests that a fundamental change in the diagnostic approach to VTE is needed, one which requires a greater appreciation that clinically apparent events are merely the tip of the thromboembolism iceberg. Conclusions-Research into a strategy of screening for subclinical VTE in these patients is needed, with a view to identifying a subgroup at risk of progression to symptomatic and life-threatening events, in whom outcome might be improved by anticoagulation. (Stroke. 2001;32:262-267.)

Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke

“…The overall incidence in our hospital is comparable to the findings of the Topas investigation. 32,33 We conclude that Lokomat therapy might be comparable to conventional gait-oriented physiotherapy when considering gait speed and walking ability in severely disabled stroke victims. The computer-aided orthosis also has a considerable number of positive side effects on muscle restoration and gait parameters.…”

Incidence of venous thromboembolism in care homes: a prospective cohort study

“…[3][4][5][6] Other important risk factors include immobilisation, hospitalisation, malignancy, previous VTE, and comorbidities such as heart failure, stroke, chronic obstructive pulmonary disease (COPD), and diabetes mellitus. [7][8][9][10][11][12][13][14] Approximately 50% of VTE is associated with hospital admission, and VTE risk assessment of hospitalised patients is strongly recommended by evidence-based guidelines. 15 It could be argued that care home residents have VTE risk profiles similar to those of medical inpatients, 16,17 although the impact of VTE risk factors in the UK care home population is unknown.…”

Profilaxis de enfermedad tromboembólica en pacientes hospitalizados con patología médica, estrechando la brecha entre las guías y la práctica clínica

“…La incidencia de TVP en pacientes con AVE y hemiplejia sin tromboprofi laxis puede alcanzar hasta 75% 18 , porcentaje similar al experimentado por pacientes operados de fractura de cadera. El TEP por su parte, es responsable de hasta 25% de las muertes precoces después de un AVE 19 . En suma, en ocasiones es difícil estimar el riesgo de desarrollar patología tromboembólica en el paciente individual y no existen herramientas validadas que faciliten hacerlo.…”