Published online before print October 21, 2004, doi: 10.1161/01.STR.0000147720.27350.09
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(Stroke. 2004;35:2911.)
© 2004 American Heart Association, Inc.
Controversies in Stroke |
Effective Prophylaxis for Deep Vein Thrombosis After Stroke
Low-Dose Anticoagulation Rather Than Stockings Alone: For
From the Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City.
Correspondence to Dr Harold P. Adams, Jr, Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242. E-mail harold-adams@uiowa.edu
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. |
Deep vein thrombosis (DVT) is an important cause of morbidity in its own right and it is complicated by pulmonary embolism, a potential cause of death after stroke.1 DVT occurs most commonly among seriously ill or elderly patients who have paralysis of the lower extremity, and it can develop in either an acute care or a rehabilitation setting.2 Because DVT can be prevented effectively, treatment guidelines rightly emphasize the importance of prophylactic measures.3
Treatment options include early ambulation, use of stockings supplemented by alternating pressure devices, and antithrombotic agents. Each option has limitations. Whereas early mobilization is recommended for mildly affected patients, seriously ill patients or those with severe motor impairments often cannot return to walking. Stockings can be used to treat bedridden patients who have an intracranial hemorrhage or another contraindication for antithrombotic agents, but data showing efficacy in the setting of stroke are limited. Any recommendation is inferred from the experience in other groups of patients.2,4 In addition, these interventions cannot be used on a long-term basis, and patients initially treated with compression stockings subsequently often need antithrombotic therapy.
Oral anticoagulants are the standard intervention for the long-term prevention of DVT, and they are effective in patients surviving stroke.5,6 Anticoagulants are the preferred therapy for patients considered to be at high risk for DVT. Their status is demonstrated by the design of clinical trials of other interventions; their usefulness is compared with the effectiveness of anticoagulation. Evidence for the efficacy of parenteral anticoagulants in preventing DVT, in a
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  H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, 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. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
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