Prevention of venous thromboembolic events in ischemic stroke
https://doi.org/10.14412/2074-2711-2013-2341
Abstract
The prevention of venous thromboembolic events (VTEEs) combining leg vein thrombosis and pulmonary thromboembolism is one of the effective areas in the management of patients with ischemic stroke. Methods for prevention of VTEEs and their risk factors in this disease are analyzed. The prevention of VTEEs involves maximally early activation of a patient with stroke, adequate fluid administration into the body, and therapeutic gymnastics. The use of unfractionated heparin (UFH) and low-molecular-weight heparins (LMWH) is effective as medications. The results of trials comparing the efficacy of UFH and LMWH in ischemic stroke are presented. Enoxaparin is noted to be superior to UFH in preventing VTEEs. The economic calculations show that the use of LMWH instead of UFH may lead to a reduction in the total cost of treatment for ischemic stroke due to the lower expenditures on therapy for VTEEs.
About the Author
Vladimir Anatolyevich Parfenov
Department of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
References
1. <div><p>Варлоу ЧП, Деннис МС, ван Гейн Ж и др. Инсульт. Практическое руководство для ведения больных. Пер. с англ. Санкт-Петербург; 1998. 629 с. [Varlou ChP, Dennis MS, van Geyn Zh i dr. Insul't. Prakticheskoe rukovodstvo dlya vedeniya bol'nykh. Per. s angl. St-Petersburg; 1998. 629 р.]</p><p>Дамулин ИВ, Парфенов ВА, Скоромец АА, Яхно НН. Нарушения кровообращения в головном и спинном мозге. В кн.: Болезни нервной системы. Руководство для врачей. Под ред. Яхно НН. Москва: Медицина; 2005. 1:с. 232–303. [Damulin IV, Parfenov VA, Skoromets AA, Yakhno NN. Narusheniya krovoobrashcheniya v golovnom i spinnom mozge. V kn.: Bolezni nervnoy sistemy. Rukovodstvo dlya vrachey. Pod red. Yakhno NN. Moskva: Meditsina; 2005. 1:р. 232–303.]</p><p>Инсульт: диагностика, лечение и профилактика. Под ред. Суслиной ЗА, Пирадова МА. Москва: МЕДпресс-информ; 2008. 288 с. [Insul't: diagnostika, lechenie i profilaktika. Pod red. Suslinoy ZA, Piradova MA. Moscow: MEDpress-inform; 2008. 288 р.]</p><p>Скворцова ВИ, Губский ЛВ, Стаховская ЛВ и др. Ишемический инсульт. В кн.: Неврология, национальное руководство. Под ред. Гусева TB, Коновалова АИ, Скворцовой ВИ. Москва: ГЭОТАР-Медиа; 2009. с. 592–615. [Skvortsova VI, Gubskiy LV, Stakhovskaya LV i dr. Ishemicheskiy insul't. V kn.: Nevrologiya, natsional'noe rukovodstvo. Pod red. Guseva TB, Konovalova AI, Skvortsovoy VI. Moscow: GEOTAR-Media; 2009. р. 592–615.]</p><p>Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 с. [Parfenov VA, Khasanova DR. Ishemicheskiy insul't. Moscow: MIA; 2012. 288 р.]</p><p>Adams HP, del Zoppo GJr, Alberts MJ et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38(5):1655–711. DOI:10.1161%2FSTROKEAHA.107.181486. Epub 2007 Apr 12.</p><p>European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis. 2008;25(5):457–507. DOI: 10.1159/000131083. Epub 2008 May 6.</p><p>Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst. Rev. 2007;(4):CD000197.</p><p>Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. Флебология. 2010;4(2–1):2–37. [Rossiyskie klinicheskie rekomendatsii po diagnostike, lecheniyu i profilaktike venoznykh tromboembolicheskikh oslozhneniy. Flebologiya. 2010;4(2–1):2–37.]</p><p>Kelly J, Rudd A, Lewis RR et al. Venous thromboembolism after acute ischemic stroke a prospective study using magnetic resonance direct thrombus imaging. Stroke. 2004;35(10):2320–6. DOI: 10.1161%2F01.STR.0000140741.13279.4f. Epub 2004 Aug 19.</p><p>Kearon C, Kahn SR, Agnelli G et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. (8th Edition). Chest. 2008;133(6 Suppl):454S–545S. DOI: 10.1378/chest.08-0658.</p><p>Warlow C, Ogston D, Douglas AS. Deep venous thrombosis of the legs after strokes. Part I – incidence and predisposing factors. BMJ. 1976;1(6019):1178–81. DOI: 10.1136%2Fbmj.1.6019.1178.</p><p>Berge E, Sandercock P. Anticoagulants versus antiplatelet agents foracute ischaemic stroke. Cochrane Database Syst Rev. 2002;(4):CD003242.</p><p>Harvey RL, Lovell LL, Belanger N, Roth EJ. The effectiveness of anticoagulant and antiplatelet agents in preventing venous thromboembolism during stroke rehabilitation: a historical cohort study. Arch Phys Med Rehabil. 2004;85(7):1070–5. DOI:10.1016%2Fj.apmr.2003.09.012.</p><p>Dennis M, Sandercock PA, Reid J et al. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet. 2009;373(9679):1958–65. DOI: 10.1016/S0140-6736(09)60941-7. Epub 2009 May 26.</p><p>International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet.1997;349(9065):1569–81.</p><p>Allen NB, Kaltenbach L, Goldstein LB et al. Regional Variation in Recommended Treatments for Ischemic Stroke and TIA: Get With the Guidelines–Stroke 2003-2010. Stroke. 2012;43(7):1858–64. DOI: 10.1161/STROKEAHA.112.652305. Epub 2012 May 15.</p><p>Tong X, Kuklina EV, Gillespie C, George MG. Medical complications among hospitalizations for ischemic stroke in the United States from 1998 to 2007. Stroke. 2010;41(5):980–6. DOI: 10.1161/STROKEAHA.110.578674. Epub 2010 Mar 4.</p><p>McCarthy ST, Turner JJ, Robertson D et al. Low-doseheparin as a prophylaxis against deep-vein thrombosis after acute stroke. Lancet. 1977;2(8042):800–1.</p><p>Hillbom M, Erila T, Sotaniemi K et al. Enoxaparin vs heparin for prevention of deep-vein thrombosis in acute ischaemic stroke: a randomized, double-blind study. Acta Neurol Scand. 2002;106(2):84–92. DOI: 10.1034%2Fj.1600-0404.2002.01215.x.</p><p>Sandercock P, Counsell C, Stobbs SL. Low-molecular-weight heparins or heparinoids versus standard unfractionated heparin for acute ischaemic stroke. Cochrane Database Syst Rev. 2005;(2):CD000119. DOI: 10.1002%2F14651858.CD000119.pub2.</p><p>Diener HC, Ringelstein EB, von Kummer R et al. PROTECT Trial Group. Prophylaxis of thrombotic and embolic events in acute ischemic stroke with the low-molecular-weight heparin certoparin: results of the PROTECT Trial. Stroke. 2006;37(1):139–44. Epub 2005 Nov 23.</p><p>Sherman DG, Albers GW, Bladin C et al. PREVAIL Investigators. The efficacy and safety of enoxaparin versus unfractionated heparin for the PREvention of Venous thromboembolism after Acute Ischaemic Stroke (PREVAIL study): an open-label randomised comparison. Lancet. 2007;369(9570):1347–55.</p><p>Kase CS, Albers GW, Bladin C et al. Neurological Outcomes in Patients With Ischemic Stroke Receiving Enoxaparin or Heparin for Venous Thromboembolism Prophylaxis: Subanalysis of the Prevention of VTE After Acute Ischemic Stroke With LMWH (PREVAIL) Study. Stroke. 2009;40(11):3532–40. DOI: 10.1161/STROKEAHA.109.555003. Epub 2009 Aug 20.</p><p>Muir KV. The PREVAIL trial and low-molecular weight heparin for prevention of venous thromboembolism. Stroke. 2008;39:2174–6. DOI: 10.1161/STROKEAHA.107.509588. Epub 2008 Apr 24.</p><p>Pineo G, Lin G, Stern L et al Economic impact of enoxaparin versus unfractionated heparin for venous thromboembolism prophylaxis in patients with acute ischemic stroke: a hospital perspective of the PREVAIL trial. J Hosp Med. 2012;7(3):176–82. DOI: 10.1002/jhm.968. Epub 2011 Nov 4.</p><p>Pineo G, Lin G, Annemans L. The economic impact of enoxaparin versus unfractionated heparin for prevention of venous thromboembolism in acute ischemic stroke patients. Clinicoecon Outcomes Res. 2012:4 99–107. DOI: 10.2147/CEOR.S30857. Epub 2012 Apr 23.</p><p>Deitelzweig SB, Becker R, Lin J, Benner J. Comparison of the two-year outcomes and costs of prophylaxis in medical patients at risk of venous thromboembolism. Thromb Haemost. 2008;100(5):810–20. DOI: 10.1160%2FTH08-04-0248.</p><p>Burleigh E, Wang C, Foster D et al. Thromboprophylaxis in medically ill patients at risk for venous thromboembolism. Am J Health Syst Pharm. 2006;63(20 Suppl 6):S23–29. DOI: 10.2146%2Fajhp060390.</p></div><br />
Review
For citations:
Parfenov VA. Prevention of venous thromboembolic events in ischemic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;5(3):49-54. (In Russ.) https://doi.org/10.14412/2074-2711-2013-2341
Views:
969
Email this article 