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(Stroke. 2004;35:2910.)
© 2004 American Heart Association, Inc.

Controversies in Stroke

Effective Prophylaxis for Deep Venous Thrombosis After Stroke

Both Low-Dose Anticoagulation and Stockings for Most Cases

From the Department of Neurology (S.M.D.), Royal Melbourne Hospital and University of Melbourne, Australia; and the The National Stroke Research Institute, Austin (G.A.D.), Repatriation Medical Centre and University of Melbourne, Australia.

Correspondence to Professor Stephen M Davis, Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia 3050. E-mail stephen.davis@mh.org.auembolism

Geoffrey A. Donnan MD, FRACP Section Editors: Stephen M. Davis MD, FRACP

Key Words: deep vein thrombosis • heparin • pulmonary embolism • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

What are the factors that underline the benefits achieved by stroke unit care? Although incompletely understood, an increased adherence to a range of processes of care is important.¹ Many of these processes are directed at the prevention of poststroke complications. Among the most important of these is prophylaxis against deep venous thrombosis (DVT) and pulmonary embolism. Although there have been a number of small trials in stroke patients demonstrating the relative safety and usefulness of low-dose anticoagulants, the evidence base is relatively small, as pointed out by Dennis.² Both protagonists consider that in patients at very high risk, there is no debate, and low-dose heparin or low-molecular-weight heparin/heparinoids should be used. Nonetheless, it would appear that Adams would advocate anticoagulation more often. Interestingly, neither seems to favor stockings as routine. Although relatively uncommon in stroke, most of us will have managed patients who are about to go from acute care to a rehabilitation unit, and who suddenly deteriorate because of life-threatening pulmonary embolism.

The risk of low-dose anticoagulation, specifically the development of symptomatic hemorrhagic transformation, appears to be quite low. The accumulated evidence for this is now quite strong.² Although Dennis draws attention to the discomfort and potential risks of stocking use, we find that they are generally well-tolerated. Systematic overview shows that graduated compression stockings are effective in diminishing the risk of DVT in hospitalized patients, even more so when combined with a form of antithrombotic therapy.³

What do we do in our practice? We recognize the inadequacy of . . . [Full Text of this Article]

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