How are deep venous thrombosis (DVT) and pulmonary embolism (PE) prevented following middle cerebral artery (MCA) stroke?

Updated: Feb 20, 2018
  • Author: Daniel I Slater, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

Pulmonary embolism (PE) accounts for 10-25 % of mortality of patients after stroke. In addition, symptomatic deep venous thrombosis (DVT) and postphlebitis syndrome impede recovery and function for patients after stroke. [9] Prevention of DVT and PE is achieved either by patient mobilization or pharmaceutical intervention. Dehydration, hemorrhagic stroke, severity of paralysis, and age are all additional risk factors associated with increased likelihood of DVT. [10]

Recent evidence has shown that graded compression stockings are of no benefit in preventing DVT and increase incidence of skin breakdown. [11] Research on the benefit of pneumatic compression devices is so far inconclusive.

Daily, low-dose, low molecular weight heparin administered subcutaneously has been shown to reduce the incidence of DVT compared with unfractionated heparin. The rate of intracranial and major extracranial hemorrhage, 1%, was equal with low molecular weight heparin and unfractionated heparin. Expense of adverse drug events per patient associated with low molecular weight heparin is also significantly lower than unfractionated heparin in patients with ischemic stroke. [12]

Consideration of DVT prevention in patients with hemorrhagic stroke is challenging owing to the significantly higher rate of DVT and risk of rebleeding. Anticoagulation, using either low molecular weight heparin or unfractionated heparin has only shown a small and nonsignificant reduction in both DVT and mortality. Class IV evidence indicates it is most likely safe to start low molecular weight heparin in patients with nonexpanding hemorrhage 3-4 days post hemorrhagic stroke.

Ongoing research is examining the impact of early mobilization of stroke patients in terms of DVT prevention and other benefits. No clear data exist to indicate adequate mobility in deciding when to stop chemoprophylaxis. [13]


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